Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3003 | TN |
NPI | 1003104571 |
---|---|
Provider Name | Derek Scott Peveler |
First Address | Hendersonville, TN 37075-3898 |
Second Address | Hendersonville, TN 37075-3898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 03/12/2014 |