Anderson, Jeremy Wade

Anderson, Jeremy Wade is an individual health care provider with primary practice located at 1642 Mcarthur St , Manchester TN 37355-2522. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Anderson, Jeremy Wade can be contacted via phone (931) 728-1315.

Contact Information

Primary practice address
1642 Mcarthur St Manchester TN 37355-2522
Phone: (931) 728-1315
Fax: (931) 728-1779
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2431 Tennessee

Profile Details

NPI number 1063405256
LBN Legal business name Anderson, Jeremy Wade
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated Jan 14th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063405256 NPPES
Tennessee Other 2431 LICENSE OD
Tennessee MEDICAID 3946295 LICENSE OD

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