Provider Demographics
NPI:1104680347
Name:ENFINGER, ROBERT S (DISPENSING OPTICIAN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:ENFINGER
Suffix:
Gender:M
Credentials:DISPENSING OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 HIGHWAY 31 W STE 101
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-3003
Mailing Address - Country:US
Mailing Address - Phone:615-581-8907
Mailing Address - Fax:
Practice Address - Street 1:2944 HIGHWAY 31 W STE 101
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-3003
Practice Address - Country:US
Practice Address - Phone:615-581-8907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO3107156F00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist