Provider Demographics
NPI:1609879741
Name:TEKIELE, BERNARD C (OD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:C
Last Name:TEKIELE
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 1:520 RIVERGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2030
Mailing Address - Country:US
Mailing Address - Phone:615-859-3937
Mailing Address - Fax:810-733-7141
Practice Address - Street 1:2501 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5626
Practice Address - Country:US
Practice Address - Phone:615-406-1571
Practice Address - Fax:615-859-3919
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALZ00115OtherVIVA HEALTH
AL51060953TEKOtherBLUE CROSS BLUE SHIELD
AL2210338OtherUNITED HEALTHCARE
AL000060953Medicaid
AL410041318OtherMEDICARE TRAVELERS
MI4799000Medicaid
MI4809545Medicaid
AL60953Medicare ID - Type UnspecifiedMEDICARE
MI4809545Medicaid
AL000060953Medicaid
MIN83480005Medicare ID - Type Unspecified