Provider Demographics
NPI:1194764365
Name:DUCKLO, JAMES L (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:DUCKLO
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:5252 HICKORY HOLLOW PKWY
Mailing Address - Street 2:SUITE 1133
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3005
Mailing Address - Country:US
Mailing Address - Phone:615-731-6230
Mailing Address - Fax:615-731-6538
Practice Address - Street 1:5252 HICKORY HOLLOW PKWY
Practice Address - Street 2:SUITE 1133
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3005
Practice Address - Country:US
Practice Address - Phone:615-731-6230
Practice Address - Fax:615-731-6538
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNODT 1233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621429478OtherPRIVATE HEALTH CARE SYSTE
TN621429478OtherUNITED HEALTHCARE
TN621429478OtherPRINCIPAL
TN3597450Medicaid
TN0118062OtherBLUE CROSS BLUE SHIELD
TN621429478OtherSUPERIOR
TNT92442Medicare UPIN
TN0118062OtherBLUE CROSS BLUE SHIELD