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

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DRS. TIDWELL, FAULKS, AND ALLEN - OPTOMETRY, PLLC

Practice address

610 Henslee Dr
Dickson, TN 37055-1211

Phone

(615) 446-2020

Fax

(615) 441-2020

NPI assigned

Jun 20, 2007

Organization subpart

No

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

Authorized official

Name

Jamie Leigh Miller, DO

Title

Certified Insurance Tech and Data E

Phone

(615) 446-2020

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 2

• TIDWELL AND FAULKS, DOCTORS OF OPTOMETRY, PLC Former legal business name
• Drs. Tidwell and Faulks Other name

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen Grant Allen, O.D.

  • Optometrist
  • Dickson, TN
  • NPI 1578970182
  Medicare reassignment Care Compare group NPD
• David Harold Faulks, OD

  • Optometrist
  • Dickson, TN
  • NPI 1982673935
  Medicare reassignment Care Compare group NPD
• Jerry Neil Tidwell, OD

  • Optometrist
  • Dickson, TN
  • NPI 1013986603
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1194920967",
    "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": {
        "organization_name": "DRS. TIDWELL, FAULKS, AND ALLEN - OPTOMETRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "CERTIFIED INSURANCE TECH AND DATA E",
        "authorized_official_telephone_number": "615-446-2020",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR DAVID FAULKS BCBST",
            "identifier": "3119266",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3595699",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3942446",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE JERRY TIDWELL",
            "identifier": "3595690",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR JERRY TIDWELL BCBST",
            "identifier": "3113993",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q007418",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR ALLEN BCBST",
            "identifier": "6022728",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TIDWELL AND FAULKS BCBST",
            "identifier": "3113988",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TIDWELL AND FAULKS, DOCTORS OF OPTOMETRY, PLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Drs. Tidwell and Faulks",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• 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 Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.