Provider Demographics
NPI:1235265901
Name:DR. D. WINSTON THAXTON 111
Entity Type:Organization
Organization Name:DR. D. WINSTON THAXTON 111
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DILLARD
Authorized Official - Middle Name:WINSTON
Authorized Official - Last Name:THAXTON
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:615-297-7547
Mailing Address - Street 1:4301 HILLSBORO PIKE
Mailing Address - Street 2:330
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3345
Mailing Address - Country:US
Mailing Address - Phone:615-297-7547
Mailing Address - Fax:615-297-7576
Practice Address - Street 1:4301 HILLSBORO PIKE
Practice Address - Street 2:330
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3345
Practice Address - Country:US
Practice Address - Phone:615-297-7547
Practice Address - Fax:615-297-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0272980001OtherDME