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NPI Code Detail

MEDICARE: DR. CHAD WILLIAM CULLISON O.D.

MEDICARE:  DR. CHAD WILLIAM CULLISON  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2365TN

General Provider Information

NPI Number : 1013050632
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD WILLIAM CULLISON O.D.
Provider Business Mailing Address
First Line : 2059 HOUSTON LEVEE RD
Second Line : SUITE #125
City : GERMANTOWN
State : TN
Zip : 38139-6970
Country : US
Telephone Number : 901-850-8572
Fax Number :
Provider Business Practice Location Address
First Line : 2059 HOUSTON LEVEE RD
Second Line : SUITE #125
City : GERMANTOWN
State : TN
Zip : 38139-6970
Country : US
Telephone Number : 901-850-8572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 08/16/2023

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Directions to “ DR. CHAD WILLIAM CULLISON O.D.” Practice Location

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