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General NPI Number Information
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NPI Number | 1417947656
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Entity Type | Individual
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Provider Name | JOSEPH D WEATHERFORD OD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 218 VILLAGE SQ SUITE 100
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City | PLEASANT VIEW
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State | TN
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Zip | 37146-7174
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Country | US
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Telephone | 931-368-1014
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Fax | 615-731-8990
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Provider Business Mailing Address
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Address Line | 218 VILLAGE SQ SUITE 100
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City | PLEASANT VIEW
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State | TN
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Zip | 37146-7174
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Country | US
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Telephone | 931-368-1014
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Fax | 615-731-8990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODT2430
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License Number State | TN
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