OrganizationDale HastyOptometristEye and Vision Services ProvidersPractice Address605 N Main St, Shelbyville, TN 37160-3210(931) 684-2020PECOS EnrollmentBased on the most recent information from CMS, provider Dale Hasty does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1245490630Provider TypeOrganizationFull NameDale HastySubpartNoEnumeration Date6/10/2008Last Updated6/10/2008Contact InformationPractice LocationPractice Address605 N Main St, Shelbyville, TN 37160-3210Phone(931) 684-2020Fax(931) 684-7000Mailing LocationMailing Address605 N Main St, Shelbyville, TN 37160-3210Phone(931) 684-2020Fax(931) 684-7000Authorized OfficialNameHasty, Kenneth Dale (Owner)Phone(934) 684-2020Provider TaxonomiesCodeDescriptionLicenseCode152W00000XPrimaryDescriptionOptometristEye and Vision Services ProvidersLicenseODT001018TennesseeProvider IdentifiersIDDescriptionIssuerID0752740001DescriptionOtherIssuerPALMETTOTennesseeID0075676DescriptionOtherIssuerBCBSTennessee