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General NPI Number Information
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NPI Number | 1982828703
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Entity Type | Individual
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Provider Name | MICHAEL J REDUS O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/28/2012
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Provider Practice Location Address
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Address Line | 1001 OVER MOUNTAIN DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2855
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Country | US
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Telephone | 423-543-3293
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Fax | 423-543-8305
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Provider Business Mailing Address
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Address Line | 1001 OVER MOUNTAIN DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2855
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Country | US
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Telephone | 423-543-3293
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Fax | 423-543-8305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5314T
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License Number State | TX
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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 | 1731
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001566
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | R-192-TA-861
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License Number State | AL
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