Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1330 | TN |
NPI | 1013047679 |
---|---|
Provider Name | Lisa Gay Williams |
First Address | Nashville, TN 37204-4035 |
Second Address | Hermitage, TN 37076-1312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U32997 | (02) |