Basic Information
| Provider Information | |||||||||
| NPI: | 1518459775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12183 DARGIE DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380029844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018678215 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1618 LEE VICTORY PKWY | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154626835 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3449 | TN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.