Individual
JARED THOMAS POWELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1747
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1747
OD
TN
05
—
3940686
—
TN
Enumeration date
08/24/2005
Last updated
02/05/2024
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