Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1665 | TN |
NPI | 1003025172 |
---|---|
Provider Name | Christina Marie Pish |
First Address | Chattanooga, TN 37421-1918 |
Second Address | Hixson, TN 37343-3727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 16/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21876 | SPECTRA (01) | TN |
4022309 | BCBS NUMBER (01) | TN |
410047075 | RAILROAD MEDICARE (01) | TN |
48445 | DAVISVISION (01) | TN |
910601 | BLOCKVISION (01) | TN |
U62763 | (02) | TN |