Provider Demographics
NPI:1962178640
Name:SPIVEY, BROOKE ASHLEY (OD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ASHLEY
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:SPIVEY
Other - Last Name:BURRESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:380 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-8490
Mailing Address - Country:US
Mailing Address - Phone:731-415-0580
Mailing Address - Fax:
Practice Address - Street 1:45 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1675
Practice Address - Country:US
Practice Address - Phone:731-352-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist