MEDICARE: FRED R SHANKS, O.D., LLC

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	558	TN

General Provider Information

NPI Number	:	1649548207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED R SHANKS, O.D., LLC

Provider Business Mailing Address
First Line	:	412 ELYSIAN FIELDS RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-4211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 ELYSIAN FIELDS RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-4211
Country	:	US
Telephone Number	:	615-834-8495
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	FRED RHEME SHANKS
Credential	:
Telephone Number	:	615-834-8495

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	05/16/2024

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