Provider Demographics
NPI:1861562035
Name:PEACE, JARROD (OD)
Entity type:Individual
Prefix:MR
First Name:JARROD
Middle Name:
Last Name:PEACE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MERIDIAN BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6344
Mailing Address - Country:US
Mailing Address - Phone:615-771-6646
Mailing Address - Fax:615-771-1191
Practice Address - Street 1:1000 MERIDIAN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6344
Practice Address - Country:US
Practice Address - Phone:615-771-6646
Practice Address - Fax:615-771-1191
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3946654Medicaid
TN3946653Medicare ID - Type Unspecified
V06697Medicare UPIN