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General NPI Number Information
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NPI Number | 1871549691
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Entity Type | Individual
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Provider Name | JOHN SCOTT GENTRY O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 2328 KNOB CREEK RD SUITE 506
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2100
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Country | US
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Telephone | 423-722-1311
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Fax | 423-926-0529
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Provider Business Mailing Address
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Address Line | 2328 KNOB CREEK RD SUITE 506
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2100
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Country | US
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Telephone | 423-722-1311
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Fax | 423-926-0529
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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 | 827
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License Number State | TN
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