Provider Demographics
NPI:1831231158
Name:MERRITT, DAVID F (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:MERRITT
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 1:130 S MAIN
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583
Mailing Address - Country:US
Mailing Address - Phone:931-836-2424
Mailing Address - Fax:931-836-1314
Practice Address - Street 1:305 N SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1300
Practice Address - Country:US
Practice Address - Phone:931-836-2424
Practice Address - Fax:931-836-1314
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3940071Medicaid
TN6225810001OtherMEDICARE DME PTAN
TN6225810001Medicare NSC
TN3940071Medicare ID - Type Unspecified
TNU57640Medicare UPIN