Jacqueline Rose Fiddler, OD
Individual provider Active NPI Optometrist · Arlington, TN
NPI 1013532480 · NPPES record last updated Jul 5, 2022
Key facts
- NPI
- 1013532480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3700 (TN)
- Practice address
- 11860 Cranston Dr
Arlington, TN 38002-4886 - Phone
- (901) 867-5540
- NPI assigned
- Jun 11, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern College of Optometry
Practice addresses (Care Compare)
1245 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3385
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200806003793 | MO | Practitioner - Optometry | 6103241757 | Reassigns benefits to 1 organization |
| I20210908000980 | TN | Practitioner - Optometry | 6103241757 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3700 | TN | MD | Pharmacist |
Practice roles (6 of 11)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Eyecare, PLC | Optometrist | Current |
Accepting new patients |
| Southern College of Optometry | Optometrist | Current |
Accepting new patients |
| Dr. Angela Milam & Associates, PLLC | Optometrist | Current |
Accepting new patients |
| Southern College of Optometry | Optometrist | Past |
Accepting new patients |
| Christina J. Levi O D P C | Optometrist | Past | Accepting new patients |
| Christina J. Levi O D P C | Optometrist | Past | Accepting new patients |
Locations
11860 Cranston Dr
Arlington, TN 38002
Phone (901) 867-5540
2021 N Highland Ave
Ste B6
Jackson, TN 38305
Phone (731) 664-6198
2100 Pleasant Plains Ext Rd
Ste C
Jackson, TN 38305
Phone (731) 664-6197
212 Rawlins Service Ct
Memphis, TN 38152
Phone (901) 252-3697
2760 N Germantown Pkwy
Ste 109
Memphis, TN 38133
Phone (901) 373-5530
1350 Concourse Ave
Ste 264
Memphis, TN 38104
Phone (901) 252-3670
1245 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250
Networks
- KY PPO C-SNP
- KY PPO
- MS PPO C-SNP
- MS PPO D-SNP
- MS PPO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2020014960 | MO | |
| Optometrist | 152W00000X | 3700 | TN | Yes |
Addresses
Primary practice location
11860 Cranston Dr
Arlington, TN 38002-4886
Mailing address
11860 Cranston Dr
Arlington, TN 38002-4886
Phone (901) 867-5540
Other providers in Arlington, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.