Provider Demographics
NPI:1326121336
Name:DODD, JOHN D (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:DODD
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 1:609 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834
Mailing Address - Country:US
Mailing Address - Phone:662-286-5671
Mailing Address - Fax:662-287-2222
Practice Address - Street 1:609 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834
Practice Address - Country:US
Practice Address - Phone:662-286-5671
Practice Address - Fax:662-287-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS501152W00000X
TN850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6533OtherUNISON DAVIS VISION
TN6924OtherMMC TLC
MS00087924Medicaid
TN919431OtherUAHC VESTICA
P0024159OtherPALMETTO GBA RAILROAD
TN39653OtherDAVIS VISION
MS2230019OtherUNITED HEALTHCARE
25487OtherSPECTERA
TN3014173OtherBCBSTN
TN3014173OtherTNCARE SELECT
TN4599113OtherMEDICAID
MS2230019OtherUNITED HEALTHCARE
TN3014173OtherTNCARE SELECT
P0024159OtherPALMETTO GBA RAILROAD