Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 719 | TN |
NPI | 1043430481 |
---|---|
Provider Name | Mrs. Martha L Davis |
First Address | Maryville, TN 37804-5800 |
Second Address | Maryville, TN 37804-5800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 19/12/2011 |