Basic Information
| Provider Information | |||||||||
| NPI: | 1659738383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VANDERBILT UNIVERSITY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 THOMPSON LN STE 30330 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372044701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159362000 | ||||||||
| FaxNumber: | 6159366065 | ||||||||
| Practice Location | |||||||||
| Address1: | 1670 W MAIN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370871345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154535155 | ||||||||
| FaxNumber: | 6154445915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2016 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | PINSON | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | WRIGHT | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE CHANCELLOR FOR HEALTH AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 6159362000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | TN | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.