John Robert Deharde, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD1192 Issued in TN

Practice address

1880 N Main St
Shelbyville, TN 37160-2018

Phone

(931) 680-3035

NPI assigned

Jan 10, 2007

Last updated

Jul 31, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• TN Doctors of Optometry, PLLC

  • Optometrist
  • Collierville, TN
  • NPI 1538827050
  Medicare reassignment NPD
• TN Doctors of Optometry, PLLC

  • Eyewear Supplier
  • Kingsport, TN
  • NPI 1275299562

  Optometrist

  NPD

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185840000000",
    "number": "1699824326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1056",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370111056",
            "telephone_number": "931-680-3035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 N MAIN ST",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371602018",
            "telephone_number": "931-680-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEHARDE",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD1192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "47939",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "45397",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF TN",
            "identifier": "0105045",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Elizabeth Davis
• Jay Gibson Davis, D.D.S.
• Amber Dawson, RN
• Alexis Y De la Paz-Tavera
• Mindy Deal, PHARMD
• Kiwana N Derrick, RN, AGNP-C
• Dialysis Clinic Inc.
• Digestive Healthcare of Central Tennessee, PLLC
• Charles W Dinwiddie, CRNA
• John Mason Douglas, FNP-BC

• Optometrist in Shelbyville, TN
• Providers in Shelbyville, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.