MEDICARE: DR. JODI SHAUN HOLBROOK OD

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
1	152W00000X	Optometrist	OD0000002312	TN

General Provider Information

NPI Number	:	1225089758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI SHAUN HOLBROOK OD

Provider Business Mailing Address
First Line	:	7514 SCENIC HWY
Second Line	:
City	:	RISING FAWN
State	:	GA
Zip	:	30738-4376
Country	:	US
Telephone Number	:	706-398-3355
Fax Number	:	423-821-1073

Provider Business Practice Location Address
First Line	:	3428 CUMMINGS HWY
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2309
Country	:	US
Telephone Number	:	423-821-1132
Fax Number	:	423-821-1073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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