Organization
KENNETH W. NIX, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANN VANDYKEN (OFFICE MANAGER)
(423) 949-3937
Entity
Organization
Contact information
Practice address
15247 RANKIN AVE, DUNLAP, TN 37327
(423) 949-3937
(423) 949-7435
Mailing address
PO BOX 1449, DUNLAP, TN 37327-1449
(423) 949-3937
(423) 949-7435
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT617
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3594241
—
TN
Enumeration date
04/29/2008
Last updated
04/29/2008
Update your record
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