Provider Demographics
NPI:1275544041
Name:OGLESBY, FRANK L JR (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:L
Last Name:OGLESBY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1599 FORT HENRY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2535
Mailing Address - Country:US
Mailing Address - Phone:423-246-2381
Mailing Address - Fax:423-246-2301
Practice Address - Street 1:1599 FORT HENRY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2535
Practice Address - Country:US
Practice Address - Phone:423-246-2381
Practice Address - Fax:423-246-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010274648Medicaid
TNT61275Medicare UPIN
TN3595938Medicare ID - Type Unspecified
VA010274648Medicaid