Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3406 | TN |
NPI | 1013438050 |
---|---|
Provider Name | Shelby Haviland |
First Address | Columbia, TN 38401-4702 |
Second Address | Columbia, TN 38401-4702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2017 |
Last Update Date | 30/06/2020 |