Provider Demographics
NPI:1861487944
Name:MUSE, GREGORY LEONARD (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEONARD
Last Name:MUSE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2336
Mailing Address - Country:US
Mailing Address - Phone:931-393-2020
Mailing Address - Fax:931-455-6501
Practice Address - Street 1:1100 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2336
Practice Address - Country:US
Practice Address - Phone:931-393-2020
Practice Address - Fax:931-455-6501
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN180037502OtherRAILROAD MEDICARE
TN3942776Medicaid
TN3942776Medicare PIN
TN3942776Medicaid