Provider Demographics
NPI:1295728863
Name:KAPPERMAN, MARK R (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:KAPPERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1720 GUNBARREL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3192
Mailing Address - Country:US
Mailing Address - Phone:423-892-2020
Mailing Address - Fax:423-855-0329
Practice Address - Street 1:1720 GUNBARREL RD
Practice Address - Street 2:STE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3192
Practice Address - Country:US
Practice Address - Phone:423-892-2020
Practice Address - Fax:423-855-0329
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0080782OtherBCBS
TN0T42064OtherUNITED HEALTHCARE
TNT61322Medicare UPIN
TN0080782OtherBCBS
TN0T42064OtherUNITED HEALTHCARE
TN0922230001Medicare NSC