Provider Demographics
NPI:1467145730
Name:ROBERTSON, JOHN FLETCHER IV (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FLETCHER
Last Name:ROBERTSON
Suffix:IV
Gender:M
Credentials:OD
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Mailing Address - Street 1:940 TAPESTRY WAY APT 4204
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3537
Mailing Address - Country:US
Mailing Address - Phone:423-202-5638
Mailing Address - Fax:
Practice Address - Street 1:90 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6474
Practice Address - Country:US
Practice Address - Phone:865-482-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1467145730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist