Provider Demographics
NPI:1912566449
Name:HOWARD, VICTORIA ASHLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ASHLEY
Last Name:HOWARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 HIGH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3798
Mailing Address - Country:US
Mailing Address - Phone:423-912-7743
Mailing Address - Fax:
Practice Address - Street 1:629 BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2221
Practice Address - Country:US
Practice Address - Phone:423-543-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist