Provider Demographics
NPI:1194172866
Name:BABB-POVEROMO, CAROLINE P
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:P
Last Name:BABB-POVEROMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 MAYNARDVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5348
Mailing Address - Country:US
Mailing Address - Phone:865-922-3937
Mailing Address - Fax:865-922-8412
Practice Address - Street 1:6719 MAYNARDVILLE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-5348
Practice Address - Country:US
Practice Address - Phone:865-922-3937
Practice Address - Fax:865-922-8412
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN3284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN3284OtherSTATE LICENSE