Provider Demographics
NPI:1841276904
Name:KEGARISE, JEFFREY L (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:KEGARISE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3252 ASPEN GROVE DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7216
Mailing Address - Country:US
Mailing Address - Phone:615-771-7555
Mailing Address - Fax:615-771-7773
Practice Address - Street 1:3252 ASPEN GROVE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7215
Practice Address - Country:US
Practice Address - Phone:615-771-7555
Practice Address - Fax:615-771-7773
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT14142Medicare UPIN
TN3943784Medicare PIN