Active NPI
Darwin L Mormon, O.D.
- Optometrist
- Germantown, TN
National Provider Identifier
1417039785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TOD 477
- Practice address
- 9031 Valley Crest LN
Germantown, TN 38138-7829 - Phone
- (901) 757-2020
- Fax
- (901) 751-2399
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TOD 477 | TN | Primary |
Addresses
Primary practice location
9031 Valley Crest LN
Germantown, TN 38138-7829
Mailing address
9031 Valley Crest LN
Germantown, TN 38138-7829
Phone (901) 757-2020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4050772 | Other | TN | BLUE CROSS BLUE SHIELD |
| EE26088 | Other | VISION CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TOD 477 | TN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621814400000",
"number": "1417039785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9031 VALLEY CREST LN",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381387829",
"telephone_number": "901-757-2020",
"fax_number": "901-751-2399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9031 VALLEY CREST LN",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381387829",
"telephone_number": "901-757-2020",
"fax_number": "901-751-2399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORMON",
"first_name": "DARWIN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2021-05-24",
"certification_date": "2021-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TN",
"license": "TOD 477",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4050772",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VISION CARE",
"identifier": "EE26088",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Germantown, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.