Gilliam, Russell Moss
Gilliam, Russell Moss is an individual health care provider with primary practice located at 1022 S Miles Ave , Union City TN 38261-5432. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Gilliam, Russell Moss can be contacted via phone (731) 885-1049.Contact Information
Primary practice address
1022 S Miles Ave
Union City TN 38261-5432
Phone: (731) 885-1049
Fax: (731) 885-6488
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | T1489 | Tennessee |
Profile Details
| NPI number | 1689775520 |
|---|---|
| LBN Legal business name | Gilliam, Russell Moss |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1689775520 | NPPES |
| Tennessee | Other | 0169173 | BCBS |
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