Provider Demographics
NPI:1861481095
Name:SPIVEY, SCOTT L (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:SPIVEY
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 1:45 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1636
Mailing Address - Country:US
Mailing Address - Phone:731-352-2473
Mailing Address - Fax:731-352-9610
Practice Address - Street 1:45 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1636
Practice Address - Country:US
Practice Address - Phone:731-352-2473
Practice Address - Fax:731-352-9610
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3599558Medicaid
TN0223380001Medicare NSC
TN3599558Medicaid
TN3599375Medicare PIN
TN410031378Medicare PIN
TN3599558Medicare PIN