Organization
EYE M D OPHTHALMOLOGY PLLC
Active
Organization
EYE M D OPHTHALMOLOGY PLLC
Active
Other names
MAHAN - RIDLEY PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEN BOB MAHAN M.D. (OWNER)
(931) 393-6004
Entity
Organization
Contact information
Practice address
926 N JACKSON ST, TULLAHOMA, TN 37388-2300
(931) 393-6004
(931) 393-4795
Mailing address
926 N JACKSON ST, TULLAHOMA, TN 37388-2300
(931) 393-6004
(931) 393-4795
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
TN-OD-T394
TN
207W00000X
Ophthalmology Physician
TN MD 9867
TN
207W00000X
Ophthalmology Physician
Primary
TN MD18870
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3711455
—
TN
Enumeration date
03/01/2007
Last updated
08/22/2017
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