Provider Demographics
NPI:1689894602
Name:TILLEY, SHERRY RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:RENEE
Last Name:TILLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-4359
Mailing Address - Country:US
Mailing Address - Phone:865-579-3920
Mailing Address - Fax:865-579-3918
Practice Address - Street 1:3001 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3614
Practice Address - Country:US
Practice Address - Phone:423-581-0360
Practice Address - Fax:423-585-4244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598339Medicare ID - Type Unspecified
TNU30505Medicare UPIN