Provider Demographics
NPI:1881797728
Name:DUCKLO, TOMMY J (OD)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:J
Last Name:DUCKLO
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 1:2114 ELLISTON PL.
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-329-0000
Mailing Address - Fax:615-327-2431
Practice Address - Street 1:2114 ELLISTON PL.
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-329-0000
Practice Address - Fax:615-327-2431
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3594535Medicaid
TN410009236OtherRAILROAD MEDICARE
TN620947940OtherCIGNA HEALTHCARE
TN620947940OtherUNITED HEALTHCARE
TN2008478OtherBLUECROSS/BLUESHIELD
TN3594535Medicaid
TN620947940OtherCIGNA HEALTHCARE
TN0387560001Medicare NSC