Organization
PRODIGY TRUST COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY CARR JESSUP OD (MANAGER)
(615) 662-2800
Entity
Organization
Contact information
Practice address
7640 HIGHWAY 70 S, STE 204, NASHVILLE, TN 37221-1758
(615) 662-2800
(615) 662-0411
Mailing address
7640 HIGHWAY 70 S, STE 204, NASHVILLE, TN 37221-1758
(615) 662-2800
(615) 662-0411
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
ODT000859
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0047504
—
TN
01
—
0792070001
MEDICARE DMERC PIN
TN
Enumeration date
06/09/2008
Last updated
06/09/2008
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