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General NPI Number Information
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NPI Number | 1962094193
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Entity Type | Organization
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Legal Business Name | HARDEMAN COUNTY VISION CENTER INC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 725 W MARKET ST
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City | BOLIVAR
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State | TN
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Zip | 38008-2242
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Country | US
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Telephone | 731-658-5197
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Fax | 731-658-5245
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Provider Business Mailing Address
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Address Line | 215 MEADOW RIDGE DR
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City | LAKELAND
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State | TN
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Zip | 38002-4880
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Country | US
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Telephone | 803-984-5278
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ELIZABETH GAULT LIGON
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Credential | OD
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Telephone | 731-658-5197
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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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