Provider Demographics
NPI:1437359353
Name:ANTONIETTE J. DRIVER
Entity Type:Organization
Organization Name:ANTONIETTE J. DRIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-968-1926
Mailing Address - Street 1:1009 E CHURCH ST
Mailing Address - Street 2:STE A
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-1930
Mailing Address - Country:US
Mailing Address - Phone:731-968-1926
Mailing Address - Fax:731-968-1996
Practice Address - Street 1:1009 E CHURCH ST
Practice Address - Street 2:STE A
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1930
Practice Address - Country:US
Practice Address - Phone:731-968-1926
Practice Address - Fax:731-968-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD 1814332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68831Medicare UPIN
TN3892120001Medicare NSC
3941512Medicare PIN