Provider Demographics
NPI:1275730343
Name:JOHN J MARIA OD PC
Entity Type:Organization
Organization Name:JOHN J MARIA OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-232-5118
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-0423
Mailing Address - Country:US
Mailing Address - Phone:931-232-5118
Mailing Address - Fax:931-232-0581
Practice Address - Street 1:1306 DONELSON PKWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3753
Practice Address - Country:US
Practice Address - Phone:931-232-5118
Practice Address - Fax:931-232-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-30
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945690Medicaid
4974560001Medicare PIN
TN3945690Medicare ID - Type UnspecifiedGROUP NUMBER
TNU55571Medicare UPIN
TN3945690Medicaid
TN3599845Medicare PIN