Individual
THOMAS A ROBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT633
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000017678
BCBS MEDICARE ADVANTAGE
TN
01
—
1238610001
DMERC
TN
05
—
3593913
—
TN
01
—
410045577
PALMETTO-GBA
TN
01
—
4406651
AETNA US HEALTHCARE
TN
01
—
621298175
DEFAULT
TN
01
—
903833
BLOCK VISION
TN
Enumeration date
07/18/2005
Last updated
07/11/2014
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