DR. JERRY NEIL TIDWELL (NPI# 1013986603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013986603 |
| Entity Type | Individual |
| Full Name | DR. JERRY NEIL TIDWELL |
| Credential | OD |
| Practice Address |
610 Henslee Dr Dickson TN 37055-1211 |
| Practice Telephone | 6154462020 |
| Practice Fax Number | 6154412020 |
| Mailing Telephone | 6154462020 |
| Mailing Fax Number | 6154412020 |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | OD0000000818 | TN | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | MEDICARE DMERC | 1250080001 | 01 |
| TN | BLUE CROSS BLUE SHIELD TN | 3113993 | 01 |
| TN | 3595690 | 05 |
| Street Address |
610 HENSLEE DR |
| City | DICKSON |
| State | TN |
| Zip Code | 37055-1211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982673935 | David Harold Faulks | Optometrist | 610 Henslee Dr, Dickson, TN 37055-1211 | 2006-03-14 |
| 1578970182 | Stephen Grant Allen | Optometrist | 610 Henslee Dr, Dickson, TN 37055-1211 | 2014-07-15 |
| 1194920967 | Drs. Tidwell, Faulks, and Allen - Optometry, Pllc | Optometrist | 610 Henslee Dr, Dickson, TN 37055-1211 | 2007-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801406186 | Raven Julia Jackson | Dentist | 445 Tn-46 S, Dickson, TN 37055 | 2020-08-03 |
| 1336767839 | Logan Newman | Student in an Organized Health Care Education/Training Program | 102 Us70 East, Suite 2, Dickson, TN 37055 | 2020-07-10 |
| 1720575012 | Vb Tennessee I Pllc | Dentist | 2027 Thornton Dr, Dickson, TX 37055 | 2018-04-23 |
| 1376075358 | Sharon Elizabeth Sharber | Nurse Practitioner | 111 Highway 70 E Ste E, Dickson, TN 37055 | 2017-03-29 |
| 1992255921 | Karen Alonzo | Occupational Therapy Assistant | 312 N Charlotte St, Dickson, TN 37055 | 2016-10-13 |
| 1356727408 | Aurora Pharmacy Inc | Pharmacy | 318 East College Street, Suite 102, Dickson, TN 37055 | 2015-07-30 |
| 1295121820 | Jeffrey Nicholas Williams | Pharmacy Technician | 120 Brazzell Rd, Dickson, TN 37055 | 2015-04-10 |
| 1760894398 | Joshua A. Vaughn | Physical Therapist | 766 Highway 46 South, Dickson, TN 37055 | 2014-06-02 |
| 1902217292 | Keith Payton | Dentist | 217 Highway 46 Ste D, Dickson, TN 37055 | 2014-05-08 |
| 1073953840 | John Harrison | Dentist | 134 Us-70, Dickson Pediatric Dentistry, Dickson, TN 37055 | 2013-06-26 |
| Find all providers in zip 37055 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497241186 | Marcus H Daniel | Optometrist | 110 Mathis Dr Ste 108, Dickson, TN 37055-2077 | 2018-07-05 |
| 1982673935 | David Harold Faulks | Optometrist | 610 Henslee Dr, Dickson, TN 37055-1211 | 2006-03-14 |
| 1083607279 | Janna Suzette Smith | Optometrist | 110 Mathis Drive, Suite 108, Dickson, TN 37055 | 2005-08-24 |
| 1578970182 | Stephen Grant Allen | Optometrist | 610 Henslee Dr, Dickson, TN 37055-1211 | 2014-07-15 |
| 1194920967 | Drs. Tidwell, Faulks, and Allen - Optometry, Pllc | Optometrist | 610 Henslee Dr, Dickson, TN 37055-1211 | 2007-06-20 |
| 1407998636 | Donald G. Davisson | Optometrist | 175 Beasley Dr, Dickson, TN 37055-2841 | 2007-02-13 |
| 1255473070 | Belinda Patrick | Optometrist | 175 Beasley Dr, Vision Center, Dickson, TN 37055-2841 | 2007-02-12 |
| 1265436083 | Lori A. Weiss | Optometrist | 110 Mathis Dr, Dickson, TN 37055-2000 | 2005-06-09 |
| 1518961325 | Donald L. Weiss Jr. | Optometrist | 110 Mathis Dr, Suite 108, Dickson, TN 37055-2000 | 2005-06-09 |
| 1467456368 | George H. Wright | Optometrist | 110 Mathis Dr, Dickson, TN 37055-2000 | 2005-06-08 |
| Find all providers in DICKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.