Organization
FAIRBANKS OCULAR PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN E SANDERS B.C.O., BADO (PRESIDENT)
(615) 322-9940
Entity
Organization
Contact information
Practice address
1720 WEST END AVE, SUITE 402, NASHVILLE, TN 37203
(615) 322-9940
(615) 320-0970
Mailing address
1720 WEST END AVE, SUITE 402, NASHVILLE, TN 37203
(615) 322-9940
(615) 320-0970
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
05-311-11
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452191
—
TN
05
—
90262916
—
KY
Enumeration date
07/04/2006
Last updated
08/22/2020
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