NPIMap

Organization Active NPI

TN Doctors of Optometry, PLLC

  • Eyewear Supplier
  • Mt Juliet, TN
National Provider Identifier
1417613639
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
TN DOCTORS OF OPTOMETRY, PLLC
Practice address
20 Old Pleasant Grove Rd Ste 200
Mt Juliet, TN 37122-3880
Phone
(615) 758-3833
Fax
(615) 773-8279
NPI assigned
Nov 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Authorized official

Name
Dolsie McDonald
Title
Manager
Phone
(726) 444-4078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

20 Old Pleasant Grove Rd Ste 200
Mt Juliet, TN 37122-3880

Mailing address

175 E Houston Street
San Antonio, TX 78205-2255
Phone (800) 340-0129

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220511000476 TN DME Supplier - Physician - Optometrist 1557754546 Practice locations: Mt Juliet, TN

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
TN Doctors of Optometry PLLC20 Old Pleasant Grove Rd, Mt Juliet, TN 37122-3880(615) 758-3833 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Feb 6, 2022

National Provider Directory

National Provider Directory
Tax ID family
TN Doctors of Optometry PLLC25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636588800000",
    "number": "1417613639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HOUSTON STREET",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052255",
            "telephone_number": "800-340-0129",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 OLD PLEASANT GROVE RD STE 200",
            "city": "MT JULIET",
            "state": "TN",
            "postal_code": "371223880",
            "telephone_number": "615-758-3833",
            "fax_number": "615-773-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TN DOCTORS OF OPTOMETRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-11",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "DOLSIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "726-444-4078"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Juliet, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; 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.