Provider Demographics
NPI:1871974345
Name:EVANS, EMILY (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 RIVERGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2030
Mailing Address - Country:US
Mailing Address - Phone:615-859-3937
Mailing Address - Fax:615-859-3919
Practice Address - Street 1:520 RIVERGATE PKWY
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2030
Practice Address - Country:US
Practice Address - Phone:615-859-3937
Practice Address - Fax:615-859-3919
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3226152W00000X
TNOD3226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015606Medicaid
TN103L413588Medicare PIN