Provider Demographics
NPI:1205880127
Name:JAYNES, MARK ALVIN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALVIN
Last Name:JAYNES
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:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-1069
Mailing Address - Country:US
Mailing Address - Phone:865-674-7300
Mailing Address - Fax:865-674-7333
Practice Address - Street 1:3116 CIRCLE STREET
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890
Practice Address - Country:US
Practice Address - Phone:865-674-7300
Practice Address - Fax:865-674-7333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT890152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3595295Medicare ID - Type Unspecified
T61238Medicare UPIN