Organization
DALE HASTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH DALE HASTY O. D. (OWNER)
(934) 684-2020
Entity
Organization
Contact information
Practice address
605 N MAIN ST, SHELBYVILLE, TN 37160-3210
(931) 684-2020
(931) 684-7000
Mailing address
605 N MAIN ST, SHELBYVILLE, TN 37160-3210
(931) 684-2020
(931) 684-7000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT001018
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0075676
BCBS
TN
01
—
0752740001
PALMETTO
TN
Enumeration date
06/10/2008
Last updated
06/10/2008
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