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General NPI Number Information
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NPI Number | 1891569158
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Entity Type | Individual
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Provider Name | MIRANDA WENTWORTH COX OD
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 4620 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-5230
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Country | US
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Telephone | 865-584-7739
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Fax | 865-584-3624
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Provider Business Mailing Address
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Address Line | 4620 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-5230
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Country | US
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Telephone | 865-584-7739
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Fax | 865-584-3624
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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 | 3851
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License Number State | TN
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