John C. Blewett, O.D.
Individual provider Active NPI Optometrist · Clarksville, TN
NPI 1679656342 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679656342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 565 (TN)
- Practice address
- 2315 Madison St
Clarksville, TN 37043-5454 - Phone
- (931) 647-9411
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 565 | TN | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 565 | TN | Yes |
Addresses
Primary practice location
2315 Madison St
Clarksville, TN 37043-5454
Mailing address
2091 Ashland City Rd
Clarksville, TN 37043-5203
Phone (931) 647-9411
Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.