Basic Information
| Provider Information | |||||||||
| NPI: | 1962471789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPICER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1928 ALCOA HWY | ||||||||
| Address2: | SUITE 324 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655249871 | ||||||||
| FaxNumber: | 8653056695 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 SMITHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378036100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656811234 | ||||||||
| FaxNumber: | 8659829746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 01486 | TN | Y | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
ID Information
| ID | Type | State | Issuer | Description | 3114334 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 3539796 | 01 | CIGNA | OTHER | 410038572 | 01 | RAILROAD MEDICARE | OTHER | 3599181 | 05 | TN | MEDICAID | 2240323 | 01 | UNITED HEALTHCARE | OTHER | 5948070 | 01 | AETNA | OTHER | 100024365 | 01 | PHP | OTHER | 3333333 | 01 | UMWA | OTHER |