Provider Demographics
NPI:1053360131
Name:CARLSON, TORREY JON (OD)
Entity type:Individual
Prefix:DR
First Name:TORREY
Middle Name:JON
Last Name:CARLSON
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 MAGNOLIA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-7442
Mailing Address - Country:US
Mailing Address - Phone:423-292-6312
Mailing Address - Fax:423-913-4141
Practice Address - Street 1:2101 FORT HENRY DR SPC E-9
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3658
Practice Address - Country:US
Practice Address - Phone:865-217-1010
Practice Address - Fax:865-444-4827
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4073509OtherBCBS
TN3940184Medicare PIN
TN4073509OtherBCBS