Dr Fred Davis and Associates

Primary specialty

OptometristTaxonomy code 152W00000X

License

1177 Issued in TN

Legal business name

DR FRED DAVIS AND ASSOCIATES

Practice address

615 S Cumberland St
Lebanon, TN 37087-5107

Phone

(615) 449-9000

Fax

(615) 444-5940

NPI assigned

Sep 16, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Jolene M Hendrickson

Title

Office Manager

Phone

(615) 449-9000

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253059200000",
    "number": "1659604189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S CUMBERLAND ST",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370875107",
            "telephone_number": "615-449-9000",
            "fax_number": "615-444-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S CUMBERLAND ST",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370875107",
            "telephone_number": "615-449-9000",
            "fax_number": "615-444-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR FRED DAVIS AND ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2009-09-16",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "JOLENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-449-9000",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "1177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "35966341",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.