Healthcare Provider Details

I. General information

NPI: 1720094519
Provider Name (Legal Business Name): BETH M SPANN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 423-587-7337
  • Fax: 423-586-0614
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTN1764
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: