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NPI Code Detail

MEDICARE: JEFFRY M CARKNER OD

MEDICARE: JEFFRY M CARKNER OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3498TN
2152W00000XOptometrist2404ATIOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1086448003OTHERORBCBS
292713OTHERORPROVIDENCE
3930613756OTHERORAETNA HEALTH PLANS

General Provider Information

NPI Number : 1891885612
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFRY M CARKNER OD
Provider Business Mailing Address
First Line : 6117 OOLTEWAH GEORGETOWN RD STE 109
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-5611
Country : US
Telephone Number : 423-238-3290
Fax Number :
Provider Business Practice Location Address
First Line : 6117 OOLTEWAH GEORGETOWN RD STE 109
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-5611
Country : US
Telephone Number : 423-238-3290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 04/23/2026

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