MEDICARE: TOMMY J. DUCKLO, OD PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578733481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMMY J. DUCKLO, OD PC

Provider Business Mailing Address
First Line	:	2114 ELLISTON PL
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5238
Country	:	US
Telephone Number	:	615-329-0000
Fax Number	:	615-327-2431

Provider Business Practice Location Address
First Line	:	2114 ELLISTON PL
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5238
Country	:	US
Telephone Number	:	615-329-0000
Fax Number	:	615-327-2431

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TOMMY J. DUCKLO
Credential	:	OD
Telephone Number	:	615-329-0000

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	08/06/2014

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