Provider Demographics
NPI:1407025968
Name:TAMMY HOLSCLAW-JONES OD PLLC
Entity Type:Organization
Organization Name:TAMMY HOLSCLAW-JONES OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLSCLAW-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-543-6868
Mailing Address - Street 1:210 ROGOSIN DR.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643
Mailing Address - Country:US
Mailing Address - Phone:423-543-6868
Mailing Address - Fax:423-543-4226
Practice Address - Street 1:210 ROGOSIN DR.
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643
Practice Address - Country:US
Practice Address - Phone:423-543-6868
Practice Address - Fax:423-543-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 332H00000X
TNODT0000001180332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4917720001Medicare NSC