MEDICARE: JEREMY L DIAMOND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODT2748	TN

General Provider Information

NPI Number	:	1316376155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMY L DIAMOND

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-0247
Country	:	US
Telephone Number	:	865-475-8680
Fax Number	:	865-475-8681

Provider Business Practice Location Address
First Line	:	741 E BROADWAY BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-4907
Country	:	US
Telephone Number	:	865-475-8680
Fax Number	:	865-475-8681

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JEREMY LEN DIAMOND
Credential	:	O.D.
Telephone Number	:	423-200-4425

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	02/10/2017

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