Healthcare Provider Details

I. General information

NPI: 1346219938
Provider Name (Legal Business Name): ROBERT KEVIN CROSS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11124 KINGSTON PIKE STE 127
KNOXVILLE TN
37934-2855
US

IV. Provider business mailing address

11124 KINGSTON PIKE STE 127
KNOXVILLE TN
37934-2855
US

V. Phone/Fax

Practice location:
  • Phone: 865-966-2020
  • Fax:
Mailing address:
  • Phone: 865-966-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number01091
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: