Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2253 | TN |
NPI | 1235199985 |
---|---|
Provider Name | Dr. Brian Bruce Dubes |
First Address | Lenoir City, TN 37771-6781 |
Second Address | Crossville, TN 38555-8756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T01138 | (02) | TN |