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General NPI Number Information
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NPI Number | 1053360131
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Entity Type | Individual
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Provider Name | TORREY JON CARLSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2101 FORT HENRY DR SPC E-9
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City | KINGSPORT
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State | TN
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Zip | 37664-3658
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Country | US
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Telephone | 865-217-1010
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Fax | 865-444-4827
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Provider Business Mailing Address
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Address Line | 505 MAGNOLIA RIDGE DR
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City | JONESBOROUGH
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State | TN
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Zip | 37659-7442
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Country | US
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Telephone | 423-292-6312
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Fax | 423-913-4141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TN1695
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License Number State | TN
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