MEDICARE: DR. JESSICA ANN DITTO O.D.

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	OD0000002695	TN

General Provider Information

NPI Number	:	1114099132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA ANN DITTO O.D.

Provider Business Mailing Address
First Line	:	1407 BEECH GROVE WAY
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-6653
Country	:	US
Telephone Number	:	615-440-0837
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 N CASTLE HEIGHTS AVE STE A
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-1512
Country	:	US
Telephone Number	:	615-449-0541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	06/15/2022

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