Provider Demographics
NPI:1548394703
Name:CRITTENDEN, JIMMY EARL (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:EARL
Last Name:CRITTENDEN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 DOSSETT ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4455
Mailing Address - Country:US
Mailing Address - Phone:423-746-8806
Mailing Address - Fax:
Practice Address - Street 1:1281 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4009
Practice Address - Country:US
Practice Address - Phone:706-861-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO000424156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician