Provider Demographics
NPI:1982673935
Name:FAULKS, DAVID HAROLD (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HAROLD
Last Name:FAULKS
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 1:610 HENSLEE DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1211
Mailing Address - Country:US
Mailing Address - Phone:615-446-2020
Mailing Address - Fax:615-441-2020
Practice Address - Street 1:610 HENSLEE DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1211
Practice Address - Country:US
Practice Address - Phone:615-446-2020
Practice Address - Fax:615-441-2020
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1250080001OtherMEDICARE DMERC
TN3942446Medicaid
TN3119266OtherBLUE CROSS BLUE SHIELD TN
TN3119266OtherBLUE CROSS BLUE SHIELD TN
TN3942446Medicare ID - Type Unspecified