Provider Demographics
NPI:1427224781
Name:HUDDLESTON AND SHEPHERD FAMILY VISION
Entity type:Organization
Organization Name:HUDDLESTON AND SHEPHERD FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-526-2022
Mailing Address - Street 1:45 N DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3372
Mailing Address - Country:US
Mailing Address - Phone:931-526-2022
Mailing Address - Fax:931-528-1230
Practice Address - Street 1:45 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3372
Practice Address - Country:US
Practice Address - Phone:931-526-2022
Practice Address - Fax:931-528-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT61221Medicare UPIN