Most Relevant Information
Provider Data
| NPI Number: | 1003508797 |
| Provider Name: | TAYLOR GRACE TACKETT DOCTOR OF OPTOMETRY |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | S-F21 |
Most Important Dates
| Enumeration Date: | 05/22/2023 |
| Last Updated: | 06/07/2023 |
Provider Practice Location
14378 HIGHWAY 43
RUSSELLVILLE
AL
356532568
Practice Location Phone/Fax
| Phone: | 2563321355 |
| Fax: |
Provider Mailing Location
7087 HIGHWAY 524
RUSSELLVILLE
AL
356536552
Provider Mailing Phone/Fax
| Phone: | 2564605793 |
| Fax: |