Organization
EYECARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL MOSS GILLIAM O.D. (OPTOMETRIST)
(731) 587-3555
Entity
Organization
Contact information
Practice address
107 KENNEDY DR, MARTIN, TN 38237-3309
(731) 587-3555
(731) 587-9003
Mailing address
107 KENNEDY DR, MARTIN, TN 38237-3309
(731) 587-3555
(731) 587-9003
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
04/30/2008
Last updated
11/20/2009
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