MEDICARE: DR. TOMMY J. DUCKLO OD

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	0696	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410009236	OTHER	TN	RAILROAD MEDICARE

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
3	620947940	OTHER	TN	CIGNA HEALTHCARE
4	620947940	OTHER	TN	UNITED HEALTHCARE
5	2008478	OTHER	TN	BLUECROSS/BLUESHIELD

General Provider Information

NPI Number	:	1881797728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMMY J. DUCKLO OD

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

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	06/10/2013

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