Provider Demographics
NPI:1326088410
Name:SILBERNAGEL, JEFFREY S (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:SILBERNAGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 W BLOUNT AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1106
Mailing Address - Country:US
Mailing Address - Phone:504-616-4780
Mailing Address - Fax:
Practice Address - Street 1:10745 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3002
Practice Address - Country:US
Practice Address - Phone:865-288-3235
Practice Address - Fax:865-288-7714
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1057-264T152W00000X
TN1340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020782Medicaid
TNQ008339Medicaid
LA1931870Medicaid
TN3371152OtherMEDICARE
LA49964Medicare PIN