Provider Demographics
NPI:1861517674
Name:BALTIER, RHONDA ANDERSON (OD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:ANDERSON
Last Name:BALTIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1595 COURTFIELD LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-4507
Mailing Address - Country:US
Mailing Address - Phone:901-755-9045
Mailing Address - Fax:901-755-7013
Practice Address - Street 1:577 N. GERMANTOWN RD.
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-755-9045
Practice Address - Fax:901-755-7013
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3940017Medicare ID - Type Unspecified