Provider Demographics
NPI:1356961213
Name:KAPPERMAN, CONNER MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:CONNER
Middle Name:MICHAEL
Last Name:KAPPERMAN
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 1:1720 GUNBARREL RD STE 100
Mailing Address - Street 2:
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:
Practice Address - Street 1:1720 GUNBARREL RD STE 100
Practice Address - Street 2:
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:2020-04-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2642152W00000X
OK3079152W00000X
390200000X
TN3649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program