Provider Demographics
NPI:1386692861
Name:ALTMAN, BRAD ALAN (OD, FSLS)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALAN
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:OD, FSLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 CROSSINGS CIR STE 100A
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8567
Mailing Address - Country:US
Mailing Address - Phone:615-535-9787
Mailing Address - Fax:615-535-9977
Practice Address - Street 1:5003 CROSSINGS CIR STE 100A
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8567
Practice Address - Country:US
Practice Address - Phone:615-535-9787
Practice Address - Fax:615-535-9977
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1598152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU56830Medicare UPIN
TN3599910Medicare ID - Type Unspecified