Healthcare Provider Details

I. General information

NPI: 1285889311
Provider Name (Legal Business Name): MATTHEW MELTON COLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12744 KINGSTON PIKE STE 108
KNOXVILLE TN
37934
US

IV. Provider business mailing address

1124 E WEISGARBER RD STE 104
KNOXVILLE TN
37909-2686
US

V. Phone/Fax

Practice location:
  • Phone: 658-584-0905
  • Fax: 865-392-5533
Mailing address:
  • Phone: 865-584-0905
  • Fax: 865-584-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberTP334
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4196
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD49890
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number49890
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: