Provider Demographics
NPI:1578565008
Name:JAWORSKI, STEVEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:JAWORSKI
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 1:4511 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5035
Mailing Address - Country:US
Mailing Address - Phone:423-870-3742
Mailing Address - Fax:423-877-9494
Practice Address - Street 1:4511 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5035
Practice Address - Country:US
Practice Address - Phone:423-870-3742
Practice Address - Fax:423-877-9494
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2240043OtherUNITED HEALTHCARE
TN3595966Medicaid
0090286OtherBLUE CROSS
TN3595966Medicare PIN
T61277Medicare UPIN