Provider Demographics
NPI:1417947656
Name:WEATHERFORD, JOSEPH D (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:WEATHERFORD
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 1:218 VILLAGE SQ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-7174
Mailing Address - Country:US
Mailing Address - Phone:931-368-1014
Mailing Address - Fax:615-731-8990
Practice Address - Street 1:218 VILLAGE SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-7174
Practice Address - Country:US
Practice Address - Phone:931-368-1014
Practice Address - Fax:615-731-8990
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT2430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3329158OtherAETNA
TN4066512OtherBCBS
TN4082435OtherBCBS
TN4092400OtherBCBS
TN921647OtherBLOCK
TN7668469OtherAETNA
TNTN2430OtherEYEMED
TN3945856Medicaid
TN4066484OtherBCBS
TN3505772OtherAETNA
TN4092400OtherBCBS
TN4066512OtherBCBS
TNU96498Medicare UPIN
TN3329158OtherAETNA
TN3505772OtherAETNA
TN4066484OtherBCBS
TN3945857Medicare ID - Type Unspecified