Basic Information
| Provider Information | |||||||||
| NPI: | 1326442559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVID | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | MILLISON LANE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 POINTE CENTRE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238936500 | ||||||||
| FaxNumber: | 4232964751 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 POINTE CENTRE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238936500 | ||||||||
| FaxNumber: | 4232964751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2014 | ||||||||
| LastUpdateDate: | 04/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1847 | SC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.