Individual
DR. NATHAN D DEDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD, FAAO
Contact information
Practice address
4430 MISSOURI AVE # 1267, FORT LEONARD WOOD, MO 65473-9098
(505) 249-9251
Mailing address
4430 MISSOURI AVE # 1267, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0048
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3451
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002
STATE LICENSE
TX
01
—
3451
STATE LICENSE
TN
Enumeration date
09/05/2018
Last updated
01/12/2024
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