Provider Demographics
NPI:1477586675
Name:MARIA, JOHN J (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MARIA
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 1:1306 DONELSON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-3753
Mailing Address - Country:US
Mailing Address - Phone:931-232-5118
Mailing Address - Fax:931-232-0581
Practice Address - Street 1:1306 DONELSON PKWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3753
Practice Address - Country:US
Practice Address - Phone:931-232-5118
Practice Address - Fax:931-232-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN1471OtherSTATE LICENSE NUMBER
TN3599845Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TNU55571Medicare UPIN
TN3945690Medicare ID - Type UnspecifiedMEDICARE CLAIM NUMBER