Individual
DR. CHARLES AVERY RICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
207 WEST STATE LINE, SOUTH FULTON, TN 38257
(731) 479-1334
(731) 479-1334
Mailing address
PO BOX 5200, 207 WEST STATELINE, SOUTH FULTON, TN 38257
(731) 479-1334
(431) 479-1334
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0662
TN
152W00000X
Optometrist
0831DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0073836
BCBS TN
TN
01
—
410047175
RAILROAD MEDICARE
—
01
—
77008316
KY MEDICAID
KY
Enumeration date
01/03/2006
Last updated
11/27/2012
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