Provider Demographics
NPI:1932124146
Name:MAPLES, JENNIFER GAIL MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GAIL MARTIN
Last Name:MAPLES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:GAIL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
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:865-244-2020
Mailing Address - Fax:865-684-1196
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:865-684-1196
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4277152W00000X
TNOD2499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945728Medicaid
FLHH830ZMedicare PIN
TN3946552Medicare PIN
V03872Medicare UPIN
TN3946553Medicare ID - Type Unspecified