Provider Demographics
NPI:1316376155
Name:JEREMY L DIAMOND
Entity Type:Organization
Organization Name:JEREMY L DIAMOND
Other - Org Name:DRS. MORRILL AND DIAMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:LEN
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-200-4425
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT2748152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7576640001Medicare NSC