Provider Demographics
NPI:1235199985
Name:DUBES, BRIAN BRUCE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BRUCE
Last Name:DUBES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 EXECUTIVE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-6781
Mailing Address - Country:US
Mailing Address - Phone:865-660-0036
Mailing Address - Fax:931-484-4855
Practice Address - Street 1:2542 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-8756
Practice Address - Country:US
Practice Address - Phone:931-484-6546
Practice Address - Fax:931-484-4855
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2253152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT01138Medicare UPIN
TN3945351Medicare PIN