Provider Demographics
NPI:1962471789
Name:SPICER, TIMOTHY B (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:SPICER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HWY
Mailing Address - Street 2:SUITE 324
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1502
Mailing Address - Country:US
Mailing Address - Phone:865-524-9871
Mailing Address - Fax:865-305-6695
Practice Address - Street 1:622 SMITHVIEW DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6100
Practice Address - Country:US
Practice Address - Phone:865-681-1234
Practice Address - Fax:865-982-9746
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN01486152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
3114334OtherBLUE CROSS BLUE SHIELD
3539796OtherCIGNA
410038572OtherRAILROAD MEDICARE
TN3599181Medicaid
2240323OtherUNITED HEALTHCARE
5948070OtherAETNA
100024365OtherPHP
3333333OtherUMWA
5948070OtherAETNA
100024365OtherPHP
410038572OtherRAILROAD MEDICARE