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General NPI Number Information
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NPI Number | 1649279076
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Entity Type | Individual
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Provider Name | THOMAS A ROBERSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 3458 N MOUNT JULIET RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-3011
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Country | US
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Telephone | 615-453-5155
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Fax | 615-444-5915
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Provider Business Mailing Address
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Address Line | 3548 N MOUNT JULIET RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-3061
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Country | US
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Telephone | 615-754-4733
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Fax | 615-758-7515
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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 | ODT633
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License Number State | TN
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