Provider Demographics
NPI:1366569956
Name:FLOYD, DAVID WENDELL (DPO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WENDELL
Last Name:FLOYD
Suffix:
Gender:M
Credentials:DPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 NE ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3575
Mailing Address - Country:US
Mailing Address - Phone:931-454-2000
Mailing Address - Fax:931-454-1221
Practice Address - Street 1:212 NE ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3575
Practice Address - Country:US
Practice Address - Phone:931-454-2000
Practice Address - Fax:931-454-1221
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1446156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN09043001Medicare ID - Type UnspecifiedMEDICARE NUMBER