Provider Demographics
NPI:1740263722
Name:BILLINGSLEY, SHARON M (OD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:M
Last Name:BILLINGSLEY
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 1:1124 E WEISGARBER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2686
Mailing Address - Country:US
Mailing Address - Phone:865-584-2127
Mailing Address - Fax:865-392-5536
Practice Address - Street 1:104 KELLER LN
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801
Practice Address - Country:US
Practice Address - Phone:865-681-3937
Practice Address - Fax:865-681-3422
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1436152W00000X
TN3726157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
454371OtherCLARITY VISION
100037704OtherPHP
TNQ028392Medicaid
TNQ028392Medicaid
3599166Medicare ID - Type Unspecified