Provider Demographics
NPI:1720094519
Name:SPANN, BETH M (OD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:SPANN
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 1:11124 KINGSTON PIKE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-966-2020
Mailing Address - Fax:865-966-7332
Practice Address - Street 1:7220 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6679
Practice Address - Country:US
Practice Address - Phone:865-577-4492
Practice Address - Fax:865-579-5862
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3940946Medicare ID - Type Unspecified
TNU64559Medicare UPIN