Provider Demographics
NPI:1245304914
Name:JOHN E. ANDERSON
Entity type:Organization
Organization Name:JOHN E. ANDERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-883-9595
Mailing Address - Street 1:457 DONELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3561
Mailing Address - Country:US
Mailing Address - Phone:615-883-9595
Mailing Address - Fax:615-883-9691
Practice Address - Street 1:457 DONELSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3561
Practice Address - Country:US
Practice Address - Phone:615-883-9595
Practice Address - Fax:615-883-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3953570001Medicare NSC
TN3942237Medicare ID - Type UnspecifiedTERRI D. ANDERSON
TNU71858Medicare UPIN
TN3944426Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TNU71401Medicare UPIN
TN3941356Medicare ID - Type UnspecifiedJOHN E ANDERSON