Vontillius, Jack B

Vontillius, Jack B is an sole proprietor health care provider with primary practice located at 9453 Dayton Pike , Soddy Daisy TN 37379-4751. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Vontillius, Jack B can be contacted via phone (423) 332-8222.

Contact Information

Primary practice address
9453 Dayton Pike Soddy Daisy TN 37379-4751
Phone: (423) 332-8222
Fax: (423) 332-8278
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X TUV007223 New York
Eye and Vision Services Providers / Optometrist 152W00000X OD0000002781 Tennessee
Eye and Vision Services Providers / Optometrist 152W00000X OP002631 Georgia

Profile Details

NPI number 1194906883
LBN Legal business name Vontillius, Jack B
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 21st, 2007
Last updated Jun 27th, 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1194906883 NPPES
Tennessee MEDICAID 1515043
Tennessee Other 4230667

Popular Providers