Individual
DR. KEVIN A MYSLIWIEC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2523 JACKSBORO PIKE, JACKSBORO, TN 37757-4847
(423) 566-2020
(423) 566-4245
Mailing address
PO BOX 306, FERGUSON, KY 42533-0306
(606) 492-2211
(606) 676-0873
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1429DT
KY
152W00000X
Optometrist
Primary
1843
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01260522
AMERIGROUP
—
01
—
3090877; 3154561
BCBSTN/BLUECARE/TENNCARE
TN
05
—
3941364
—
TN
05
—
3941367
—
TN
01
—
410036018
RAILROAD MEDICARE FOR JACKSBORO
—
01
—
410041149
RAILROAD MEDICARE FOR JELLICO
—
01
—
410047039
RAILROAD MEDICARE FOR ONEIDA
—
05
—
77000156
—
KY
Enumeration date
06/21/2005
Last updated
12/03/2019
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