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General NPI Number Information
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NPI Number | 1174831887
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Entity Type | Organization
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Legal Business Name | KNOXVILLE PEDIATRIC OPHTHALMOLOGY, PLLC
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 2100 W CLINCH AVE SUITE 400 KOPPEL PLAZA
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City | KNOXVILLE
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State | TN
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Zip | 37916-2219
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Country | US
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Telephone | 865-521-7998
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Fax | 865-521-7405
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Provider Business Mailing Address
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Address Line | 2100 W CLINCH AVE SUITE 400 KOPPEL PLAZA
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City | KNOXVILLE
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State | TN
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Zip | 37916-2219
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Country | US
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Telephone | 865-521-7998
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Fax | 865-521-7405
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Authorized Official
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Title or Position | OFFICE ADMIN
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Name | DEBORAH F STOFFLE
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Credential |
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Telephone | 865-521-7998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 14247
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License Number State | TN
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