Individual
DR. JERRY NEIL TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
610 HENSLEE DR, DICKSON, TN 37055-1211
(615) 446-2020
(615) 441-2020
Mailing address
610 HENSLEE DR, DICKSON, TN 37055-1211
(615) 446-2020
(615) 441-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD0000000818
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1250080001
MEDICARE DMERC
TN
01
—
3113993
BLUE CROSS BLUE SHIELD TN
TN
05
—
3595690
—
TN
Enumeration date
03/16/2006
Last updated
07/08/2007
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