Provider Demographics
NPI:1194830869
Name:BERRY, LETTIE AMANDA (OD)
Entity Type:Individual
Prefix:DR
First Name:LETTIE
Middle Name:AMANDA
Last Name:BERRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LETTIE
Other - Middle Name:AMANDA
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2268 MURFREESBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3313
Mailing Address - Country:US
Mailing Address - Phone:615-731-2020
Mailing Address - Fax:615-361-7078
Practice Address - Street 1:2268 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3313
Practice Address - Country:US
Practice Address - Phone:615-731-2020
Practice Address - Fax:615-361-7078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU29234Medicare UPIN
TN3598302Medicare ID - Type Unspecified