Organization
MODERN EYE GALLERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KIRBY (SOLE MBR)
(615) 450-0050
Entity
Organization
Contact information
Practice address
12904 LEBANON RD, MOUNT JULIET, TN 37122-2865
(615) 450-0050
Mailing address
12904 LEBANON RD, MOUNT JULIET, TN 37122-2865
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD 2759
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1523521
—
TN
Enumeration date
06/10/2016
Last updated
06/10/2016
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