Provider Demographics
NPI:1629724935
Name:OCULOPLASTIC SPECIALISTS OF TENNESSEE LLC
Entity Type:Organization
Organization Name:OCULOPLASTIC SPECIALISTS OF TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-400-5844
Mailing Address - Street 1:4306 HARDING PIKE STE 106
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2249
Mailing Address - Country:US
Mailing Address - Phone:615-297-5798
Mailing Address - Fax:
Practice Address - Street 1:4306 HARDING PIKE STE 106
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2249
Practice Address - Country:US
Practice Address - Phone:615-297-5798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy