| |
2961 Canada Rd, Suite 104, Lakeland, TN 38002-4893 | |
(901) 380-2020 | |
(901) 380-2809 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 2961 Canada Rd, Lakeland, Tennessee |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1104968338 | NPI | - | NPPES |
3940102 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | ODT 1585 (Tennessee) | Primary |
Provider Name | Barton L Powell |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1164572285 PECOS PAC ID: 4981517679 Enrollment ID: I20031110000114 |
Mailing Address | Practice Location Address |
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2961 Canada Rd, Suite 104, Lakeland, TN 38002-4893 Ph: (901) 380-2020 | 2961 Canada Rd, Suite 104, Lakeland, TN 38002-4893 Ph: (901) 380-2020 |
Dr. Barton L. Powell, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 2961 Canada Rd, Ste 104, Lakeland, TN 38002 Phone: 901-380-2020 Fax: 901-380-2809 |