Provider Demographics
NPI:1942281530
Name:SCOGGINS, JEREMY CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:CHRISTOPHER
Last Name:SCOGGINS
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 1:327 WINDHAVEN BAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6912
Mailing Address - Country:US
Mailing Address - Phone:615-491-4245
Mailing Address - Fax:615-832-4321
Practice Address - Street 1:300 PLEASANT GROVE RD
Practice Address - Street 2:BLDG 600
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3785
Practice Address - Country:US
Practice Address - Phone:615-773-5773
Practice Address - Fax:615-773-5529
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4019025OtherBCBS
TNU85495Medicare UPIN
TN3944398Medicare PIN