Andrea S Taddese, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1818DT Issued in KY

Practice address

401 S Mount Juliet Rd Ste 367
Mount Juliet, TN 37122-8544

Phone

(615) 758-0874

NPI assigned

Jul 16, 2010

Last updated

Aug 15, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• James L Ducklo OD

  dba James L Ducklo Od and Associates

  • Optometrist
  • Antioch, TN
  • NPI 1285786145
  NPD (past)
• Murfreesboro Eye Center PLLC

  dba Mount Juliet Eye Center

  • Optometrist
  • Murfreesboro, TN
  • NPI 1407589195
  NPD (past)

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

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344988800000",
    "number": "1063725208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7095 SONYA DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372095231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S MOUNT JULIET RD STE 367",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371228544",
            "telephone_number": "615-758-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADDESE",
        "first_name": "ANDREA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-16",
        "last_updated": "2012-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1818DT",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD-T3032",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Summit Family Chiropractic LLC (Tru Roots Chiropractic)
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• Erin Sumner, OTD, OTR/L
• Surgical Professionals, Inc
• Jeffrey Neil Swindell, BCBA
• Alexander Ilias Tadorian
• Nabel Ryad Tadros
• Lavanya Tammareddi, O.D.
• Allen Ervin Tate, PA
• Jennifer Tate

• Optometrist in Mount Juliet, TN
• Providers in Mount Juliet, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.