Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3677 | TN |
NPI | 1013586742 |
---|---|
Provider Name | Lindsey Caudle |
First Address | Newport, TN 37821-7264 |
Second Address | Newport, TN 37821-7264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2021 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3677 | OPTOMETRY LICENSE NUMBER (01) | TN |