Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2365 | TN |
NPI | 1013050632 |
---|---|
Provider Name | Dr. Chad William Cullison |
First Address | Germantown, TN 38139-6970 |
Second Address | Germantown, TN 38139-6970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 02/11/2010 |