Provider Demographics
NPI:1922091354
Name:POLITZER, MICHAEL R (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:POLITZER
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 1:144 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-7170
Mailing Address - Country:US
Mailing Address - Phone:615-330-3895
Mailing Address - Fax:
Practice Address - Street 1:144 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-7170
Practice Address - Country:US
Practice Address - Phone:615-330-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD000000538152WX0102X, 152WL0500X, 152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35900561Medicaid
TN4247110001OtherPALMETTO GBA
TN410048955OtherRAILROAD MEDICARE
TN4176259OtherBLUE CROSS BLUE SHIELD
TN2240252OtherUNITED HEALTHCARE
TN35900561Medicaid