Provider Demographics
NPI:1972754901
Name:DAVID L FOUTCH OD PC
Entity type:Organization
Organization Name:DAVID L FOUTCH OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:615-597-2255
Mailing Address - Street 1:2585 NASHVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-7259
Mailing Address - Country:US
Mailing Address - Phone:615-597-2255
Mailing Address - Fax:615-597-2257
Practice Address - Street 1:2585 NASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-7259
Practice Address - Country:US
Practice Address - Phone:615-597-2255
Practice Address - Fax:615-597-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0831410001Medicare NSC