Provider Demographics
NPI:1578733481
Name:TOMMY J. DUCKLO, OD PC
Entity Type:Organization
Organization Name:TOMMY J. DUCKLO, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUCKLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-329-0000
Mailing Address - Street 1:2114 ELLISTON PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5238
Mailing Address - Country:US
Mailing Address - Phone:615-329-0000
Mailing Address - Fax:615-327-2431
Practice Address - Street 1:2114 ELLISTON PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5238
Practice Address - Country:US
Practice Address - Phone:615-329-0000
Practice Address - Fax:615-327-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3942134Medicaid
TN3942134Medicaid
TN=========OtherUNITED HEALTHCARE
TN3942134Medicare PIN
TN0387560001Medicare NSC