| |
106c Karen Dr, Soddy Daisy, TN 37379-4337 | |
(423) 834-9020 | |
(423) 834-9021 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 106c Karen Dr, Soddy Daisy, Tennessee |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003154915 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | TN2767 (Tennessee) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 505, Dayton, TN 37321-0505 Ph: (423) 779-7712 | 106c Karen Dr, Soddy Daisy, TN 37379-4337 Ph: (423) 834-9020 |
Jack B Vontillius, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 9453 Dayton Pike, Soddy Daisy, TN 37379 Phone: 423-332-8222 Fax: 423-332-8278 |