Provider Demographics
NPI:1497487102
Name:TAYLOR, MIA SAMANTHA (OD)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:SAMANTHA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:MIA
Other - Middle Name:SAMANTHA
Other - Last Name:KESLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY STE 255
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1508
Mailing Address - Country:US
Mailing Address - Phone:865-244-2030
Mailing Address - Fax:865-410-7292
Practice Address - Street 1:1932 ALCOA HWY STE 255
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1508
Practice Address - Country:US
Practice Address - Phone:865-244-2020
Practice Address - Fax:865-410-7292
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2292DT152W00000X
TNOD0000003792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist