Provider Demographics
NPI:1760406011
Name:DEAN, MARION ANDREW JR
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:ANDREW
Last Name:DEAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 SMITHVILLE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110
Mailing Address - Country:US
Mailing Address - Phone:931-473-7844
Mailing Address - Fax:931-473-6844
Practice Address - Street 1:2069 SMITHVILLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-473-7844
Practice Address - Fax:931-473-6844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3942749Medicaid
OT41773OtherUNITED HEALTHCARE
TN3010167OtherBCBS
410024590OtherPALMETTO RR MEDICARE
9429243OtherCIGNA
TN0364880001Medicare NSC
410024590OtherPALMETTO RR MEDICARE
9429243OtherCIGNA