Healthcare Provider Details

I. General information

NPI: 1740263722
Provider Name (Legal Business Name): SHARON M BILLINGSLEY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 KELLER LN
MARYVILLE TN
37801
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 865-681-3937
  • Fax: 865-681-3422
Mailing address:
  • Phone: 865-584-2127
  • Fax: 865-392-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1436
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3726157
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: