Individual
DR. JEREMY WADE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2431
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2431
LICENSE OD
TN
05
—
3946295
—
TN
Enumeration date
08/24/2005
Last updated
01/14/2013
Update your record
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