Organization
OPTOMETRY GROUP ENTERPRISES, PC
Active
Other names
Optometry Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BART L. POWELL O.D. (OWNER-DOCTOR)
(901) 380-2020
Entity
Organization
Contact information
Practice address
2961 CANADA RD, SUITE 104, LAKELAND, TN 38002-4893
(901) 380-2020
(901) 380-2809
Mailing address
2961 CANADA RD, SUITE 104, LAKELAND, TN 38002-4893
(901) 380-2020
(901) 380-2809
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT 1585
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3940102
—
TN
Enumeration date
02/13/2007
Last updated
07/19/2012
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