Provider Demographics
NPI:1013050632
Name:CULLISON, CHAD WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WILLIAM
Last Name:CULLISON
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 1:2059 HOUSTON LEVEE RD
Mailing Address - Street 2:SUITE #125
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6970
Mailing Address - Country:US
Mailing Address - Phone:901-850-8572
Mailing Address - Fax:
Practice Address - Street 1:2059 HOUSTON LEVEE RD
Practice Address - Street 2:SUITE #125
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-6970
Practice Address - Country:US
Practice Address - Phone:901-850-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I416109Medicare PIN