Provider Demographics
NPI:1639239114
Name:SALYERS, GREGORY TODD (OD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TODD
Last Name:SALYERS
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 1:1936 BROOKSIDE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4654
Mailing Address - Country:US
Mailing Address - Phone:423-246-3372
Mailing Address - Fax:423-246-1184
Practice Address - Street 1:1936 BROOKSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4654
Practice Address - Country:US
Practice Address - Phone:423-246-3372
Practice Address - Fax:423-246-1184
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNOD1217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598485Medicaid
TN1055070001Medicare NSC
U35699Medicare UPIN
3598485Medicare ID - Type Unspecified