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General NPI Number Information
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NPI Number | 1902082001
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Entity Type | Organization
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Legal Business Name | DEVINEVISION
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 6549 KANUGA DR
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City | KNOXVILLE
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State | TN
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Zip | 37912-1600
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Country | US
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Telephone | 865-356-9475
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7756
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-0756
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Country | US
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Telephone | 252-985-1371
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DANIEL DEVINE
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Credential | OD
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Telephone | 615-727-0177
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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 |
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License Number State |
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