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General NPI Number Information
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NPI Number | 1841351269
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Entity Type | Organization
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Legal Business Name | SULLINS EYE CARE P.C.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 517 N JACKSON ST
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City | ATHENS
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State | TN
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Zip | 37303-3621
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Country | US
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Telephone | 423-745-4910
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Fax | 423-745-2230
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Provider Business Mailing Address
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Address Line | PO BOX 666
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City | ATHENS
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State | TN
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Zip | 37371-0666
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Country | US
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Telephone | 423-745-4910
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Fax | 423-745-2230
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | CHRISTA H SULLINS
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Credential | OD
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Telephone | 423-745-4970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD0000001689
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD0000001899
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OD0000001689
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OD0000001899
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OD0000001722
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD0000001722
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License Number State | TN
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