Provider Demographics
NPI:1437294782
Name:BRISTOW, JAMES CECIL
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CECIL
Last Name:BRISTOW
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:IDELLANN
Other - Last Name:BRISTOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LDO
Mailing Address - Street 1:1541 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6738
Mailing Address - Country:US
Mailing Address - Phone:931-484-9398
Mailing Address - Fax:931-484-9398
Practice Address - Street 1:1541 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6738
Practice Address - Country:US
Practice Address - Phone:931-484-9398
Practice Address - Fax:931-484-9398
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1376156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician