MEDICARE: THOMAS A ROBERSON 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	ODT633	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000017678	OTHER	TN	BCBS MEDICARE ADVANTAGE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	903833	OTHER	TN	BLOCK VISION
4	1238610001	OTHER	TN	DMERC
5	000017678	OTHER	TN	BLUE CROSS BLUE SHIELD TN
6	000017678	OTHER	TN	TENNCARE SELECT
7	410045577	OTHER	TN	PALMETTO-GBA
8	4406651	OTHER	TN	AETNA US HEALTHCARE
9	621298175	OTHER	TN	DEFAULT

General Provider Information

NPI Number	:	1649279076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS A ROBERSON O.D.

Provider Business Mailing Address
First Line	:	3548 N MOUNT JULIET RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3061
Country	:	US
Telephone Number	:	615-754-4733
Fax Number	:	615-758-7515

Provider Business Practice Location Address
First Line	:	3458 N MOUNT JULIET RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3011
Country	:	US
Telephone Number	:	615-453-5155
Fax Number	:	615-444-5915

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/11/2014

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Directions to “ THOMAS A ROBERSON O.D.” Practice Location

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