Provider Demographics
NPI:1184821621
Name:DIAMOND, JEREMY LEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LEN
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-0247
Mailing Address - Country:US
Mailing Address - Phone:865-475-8680
Mailing Address - Fax:865-475-8681
Practice Address - Street 1:741 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4907
Practice Address - Country:US
Practice Address - Phone:865-475-8680
Practice Address - Fax:865-475-8681
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2748152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3590667Medicare PIN
TN3590075Medicare PIN