Provider Demographics
NPI:1710951298
Name:CONN, WILLIAM E (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:CONN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:782 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4561
Mailing Address - Country:US
Mailing Address - Phone:615-373-9992
Mailing Address - Fax:615-373-9819
Practice Address - Street 1:782 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4561
Practice Address - Country:US
Practice Address - Phone:615-373-9992
Practice Address - Fax:615-373-9819
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1119T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3599310Medicaid
U49800Medicare UPIN
TN3599310Medicaid
TN0923350001Medicare NSC