Healthcare Provider Details

I. General information

NPI: 1417947656
Provider Name (Legal Business Name): JOSEPH D WEATHERFORD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 VILLAGE SQ SUITE 100
PLEASANT VIEW TN
37146-7174
US

IV. Provider business mailing address

218 VILLAGE SQ SUITE 100
PLEASANT VIEW TN
37146-7174
US

V. Phone/Fax

Practice location:
  • Phone: 931-368-1014
  • Fax: 615-731-8990
Mailing address:
  • Phone: 931-368-1014
  • Fax: 615-731-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT2430
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: