MEDICARE: DR. MARK R. KAPPERMAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD0000001120	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0080782	OTHER	TN	BCBS
2	0T42064	OTHER	TN	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1295728863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK R. KAPPERMAN OD

Provider Business Mailing Address
First Line	:	1720 GUNBARREL RD
Second Line	:	STE 100
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3192
Country	:	US
Telephone Number	:	423-892-2020
Fax Number	:	423-855-0329

Provider Business Practice Location Address
First Line	:	1720 GUNBARREL RD
Second Line	:	STE 100
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3192
Country	:	US
Telephone Number	:	423-892-2020
Fax Number	:	423-855-0329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	06/23/2008

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