Provider Demographics
NPI:1326092255
Name:NIEBER, STUART WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:WILLIAM
Last Name:NIEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MAYFIELD DR STE D2
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6302
Mailing Address - Country:US
Mailing Address - Phone:615-771-0068
Mailing Address - Fax:615-771-9784
Practice Address - Street 1:330 MAYFIELD DR STE D2
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6302
Practice Address - Country:US
Practice Address - Phone:615-771-0068
Practice Address - Fax:615-771-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3125709OtherBLUE CROSS BLUE SHIELD TN
TN3942152Medicare ID - Type Unspecified
TN3125709OtherBLUE CROSS BLUE SHIELD TN