Jerry Neil Tidwell, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD0000000818 Issued in TN

Practice address

610 Henslee Dr
Dickson, TN 37055-1211

Phone

(615) 446-2020

Fax

(615) 441-2020

NPI assigned

Mar 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DRS. Tidwell, Faulks, and Allen - Optometry, PLLCGroup PAC ID 5597886069, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• MS PPO C-SNP
• MS PPO
• MS PPO D-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DRS. Tidwell, Faulks, and Allen - Optometry, PLLC

  • Optometrist
  • Dickson, TN
  • NPI 1194920967
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013986603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 HENSLEE DR",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370551211",
            "telephone_number": "615-446-2020",
            "fax_number": "615-441-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 HENSLEE DR",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370551211",
            "telephone_number": "615-446-2020",
            "fax_number": "615-441-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JERRY",
        "middle_name": "NEIL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD0000000818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TN",
            "identifier": "3113993",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3595690",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMERC",
            "identifier": "1250080001",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Care Giving Elite, LLC
• Amanda Rae Thomas, COTL
• Lacey Kathleen Thompson, PA-C
• Robert Thuan, MD
• Alexis Sierra Tidwell
• Matthew Roach Tincher, M.D.
• Chessnee Renee Tinsley, APRN, FNP-C
• Tyler Aries Toledo, PHD
• Tonya S Davis (Urgent Medical Care)
• Daniel Torrens, D.O.

• Optometrist in Dickson, TN
• Providers in Dickson, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.