Shepherd, Garrett Clark
Shepherd, Garrett Clark is an sole proprietor health care provider with primary practice located at 45 N Dixie Ave , Cookeville TN 38501-3372. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Shepherd, Garrett Clark can be contacted via phone (931) 526-2022.Contact Information
Primary practice address
45 N Dixie Ave
Cookeville TN 38501-3372
Phone: (931) 526-2022
Fax: (931) 528-1230
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OD 0000002600 | Tennessee |
Profile Details
| NPI number | 1609827542 |
|---|---|
| LBN Legal business name | Shepherd, Garrett Clark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 15th, 2006 |
| Last updated | Sep 12th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609827542 | NPPES |
| Tennessee | Other | 4114922 | BC/BS OF TN |
| Tennessee | MEDICAID | 3946671 | BC/BS OF TN |
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