Provider Demographics
NPI:1831340330
Name:DAVID F. MERRITT, O.D.
Entity type:Organization
Organization Name:DAVID F. MERRITT, O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-836-2424
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-2215
Mailing Address - Country:US
Mailing Address - Phone:931-836-2424
Mailing Address - Fax:931-836-1314
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2215
Practice Address - Country:US
Practice Address - Phone:931-836-2424
Practice Address - Fax:931-836-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT-1636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6225810001Medicare NSC