Organization
WEST TENNESSEE SENIOR EYECARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY L NICHOLSON II OD (OWNER)
(731) 415-9368
Entity
Organization
Contact information
Practice address
460 TARA LN, HUNTINGDON, TN 38344-2110
(731) 415-9368
(731) 986-7981
Mailing address
PO BOX 7756, ROCKY MOUNT, NC 27804-0756
(252) 985-1371
(252) 467-2339
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
10/14/2009
Last updated
10/14/2009
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