Provider Demographics
NPI:1396398855
Name:IRVIN, COURTNEY CAPE (OD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CAPE
Last Name:IRVIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E TICKLE ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3119
Mailing Address - Country:US
Mailing Address - Phone:731-286-2801
Mailing Address - Fax:731-286-0052
Practice Address - Street 1:401 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3119
Practice Address - Country:US
Practice Address - Phone:731-286-2801
Practice Address - Fax:731-286-0052
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9787T152W00000X
TN3534152W00000X
GAOPT003279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist