Provider Demographics
NPI:1306831409
Name:ANDERSON, TERRI DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:DENISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 DONELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3561
Mailing Address - Country:US
Mailing Address - Phone:615-883-9595
Mailing Address - Fax:615-883-9691
Practice Address - Street 1:457 DONELSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3561
Practice Address - Country:US
Practice Address - Phone:615-883-9595
Practice Address - Fax:615-883-9691
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1833152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3942237Medicaid
TN2240219OtherUNITED HEALTH CARE
TN4012210OtherBLUE CROSS BLUE SHIELD
TN4012210OtherBLUE CROSS BLUE SHIELD
TNU71858Medicare UPIN
TN3953570001Medicare NSC