Provider Demographics
NPI:1184680878
Name:GRAVES, THOMAS L (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:GRAVES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-452-2020
Mailing Address - Fax:615-452-2112
Practice Address - Street 1:343 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-452-2020
Practice Address - Fax:615-452-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNOD0000001232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2240264OtherUNITED HEALTHCARE
TN3597174Medicare ID - Type Unspecified
TN2240264OtherUNITED HEALTHCARE
TN0725050001Medicare NSC
TN3597176Medicare PIN
U28539Medicare UPIN