Provider Demographics
NPI:1467523167
Name:KIRKCONNELL, JAMES WATSON (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WATSON
Last Name:KIRKCONNELL
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 1:7640 HWY 70 SOUTH, STE 102
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1758
Mailing Address - Country:US
Mailing Address - Phone:615-662-7588
Mailing Address - Fax:615-662-7988
Practice Address - Street 1:137 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2717
Practice Address - Country:US
Practice Address - Phone:615-452-2111
Practice Address - Fax:615-452-2251
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002307152W00000X
TNOD2307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU22774TNMedicare UPIN
VA410001000Medicare ID - Type Unspecified
TNU22774Medicare UPIN