Individual
DR. JOHN ROBERT DEHARDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1880 N MAIN ST, SHELBYVILLE, TN 37160-2018
(931) 680-3035
Mailing address
PO BOX 1056, ANTIOCH, TN 37011-1056
(931) 680-3035
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD1192
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105045
BC BS OF TN
TN
01
—
45397
SPECTERA
—
01
—
47939
DAVIS VISION
—
Enumeration date
01/10/2007
Last updated
07/31/2007
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