Provider Demographics
NPI:1356498828
Name:PERSONS, COREY GLENN (OD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:GLENN
Last Name:PERSONS
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 1:1340 UNION UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3780
Mailing Address - Country:US
Mailing Address - Phone:731-424-2414
Mailing Address - Fax:731-424-4444
Practice Address - Street 1:1340 UNION UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3780
Practice Address - Country:US
Practice Address - Phone:731-424-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10156152W00000X
TN1779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist