Provider Demographics
NPI:1649848235
Name:OLIVER, JOSHUA (OD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:OLIVER
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 1:999 GUARDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1722
Mailing Address - Country:US
Mailing Address - Phone:931-650-4100
Mailing Address - Fax:931-650-4101
Practice Address - Street 1:999 GUARDIAN WAY
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1722
Practice Address - Country:US
Practice Address - Phone:931-650-4100
Practice Address - Fax:931-650-4101
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003018152W00000X
TNOD3686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty