Provider Demographics
NPI:1700903648
Name:GOULD, JAMES ANDERSON (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDERSON
Last Name:GOULD
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 1:401 BONNAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1052
Mailing Address - Country:US
Mailing Address - Phone:615-902-0530
Mailing Address - Fax:
Practice Address - Street 1:1000 RIVERGATE PKWY
Practice Address - Street 2:SEARS BUILDING RIVERGATE MALL
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2402
Practice Address - Country:US
Practice Address - Phone:615-851-7022
Practice Address - Fax:615-859-7801
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3594269Medicare ID - Type UnspecifiedMC
TNU-48276Medicare UPIN