Provider Demographics
NPI:1801075346
Name:DR. J. SCOTT GENTRY, O.D., P.C,
Entity type:Organization
Organization Name:DR. J. SCOTT GENTRY, O.D., P.C,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-926-2642
Mailing Address - Street 1:301 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5629
Mailing Address - Country:US
Mailing Address - Phone:423-926-2642
Mailing Address - Fax:
Practice Address - Street 1:301 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5629
Practice Address - Country:US
Practice Address - Phone:423-926-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU20270Medicare UPIN
TN3596084Medicare PIN