Provider Demographics
NPI:1013925791
Name:PUMPHREY, ZACHARY (OD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:PUMPHREY
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 1:321 E ELK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3221
Mailing Address - Country:US
Mailing Address - Phone:423-542-2512
Mailing Address - Fax:423-542-0477
Practice Address - Street 1:321 E ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3221
Practice Address - Country:US
Practice Address - Phone:423-542-2512
Practice Address - Fax:423-542-0477
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2692152W00000X
OK2498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4157039OtherBLUE CROSS BLUE SHIELD TN
TNP00914239OtherMEDICARE RAILROAD
TNV10633Medicare UPIN
TN103I416180Medicare PIN
TN4157039OtherBLUE CROSS BLUE SHIELD TN