Organization
DR FRED DAVIS AND ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JOLENE M HENDRICKSON (OFFICE MANAGER)
(615) 449-9000
Entity
Organization
Contact information
Practice address
615 S CUMBERLAND ST, LEBANON, TN 37087-5107
(615) 449-9000
(615) 444-5940
Mailing address
615 S CUMBERLAND ST, LEBANON, TN 37087-5107
(615) 449-9000
(615) 444-5940
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1177
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35966341
MEDICARE PTAN
TN
Enumeration date
09/16/2009
Last updated
09/16/2009
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