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General NPI Number Information
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NPI Number | 1871610139
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Entity Type | Organization
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Legal Business Name | NORTHWEST TENNESSEE EYE CLINIC, PC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 111 HIGHWAY 431
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City | MARTIN
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State | TN
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Zip | 38237-8264
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Country | US
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Telephone | 731-587-2022
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Fax | 731-587-9397
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Provider Business Mailing Address
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Address Line | 111 HIGHWAY 431
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City | MARTIN
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State | TN
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Zip | 38237-8264
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Country | US
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Telephone | 731-587-2022
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Fax | 731-587-9397
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MICHELE BROWN
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Credential |
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Telephone | 731-587-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | TN1767
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License Number State | TN
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