Provider Demographics
NPI:1891569158
Name:COX, MIRANDA WENTWORTH (OD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:WENTWORTH
Last Name:COX
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 1:4620 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5230
Mailing Address - Country:US
Mailing Address - Phone:865-584-7739
Mailing Address - Fax:865-584-3624
Practice Address - Street 1:4620 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5230
Practice Address - Country:US
Practice Address - Phone:865-584-7739
Practice Address - Fax:865-584-3624
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist