Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 02294-14 | TN |
NPI | 1346343928 |
---|---|
Provider Name | Mr. Scott D Fiscus |
First Address | Nashville, TN 37204-2709 |
Second Address | Nashville, TN 37204-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 18/08/2016 |