Provider Demographics
NPI:1891885612
Name:CARKNER, JEFFRY M (OD)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:M
Last Name:CARKNER
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 OOLTEWAH GEORGETOWN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5611
Mailing Address - Country:US
Mailing Address - Phone:423-238-3290
Mailing Address - Fax:
Practice Address - Street 1:6117 OOLTEWAH GEORGETOWN RD STE 109
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5611
Practice Address - Country:US
Practice Address - Phone:423-238-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2404ATI152W00000X
TN3498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR086448003OtherBCBS
OR92713OtherPROVIDENCE
OR930613756OtherAETNA HEALTH PLANS