Individual
SANDY L MYSLIWIEC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2523 JACKSBORO PIKE, JACKSBORO, TN 37757-4847
(423) 566-2020
(423) 566-4245
Mailing address
PO BOX 296, FERGUSON, KY 42533-0296
(606) 492-2211
(606) 676-0873
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1926
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0487990009
JACKSBORO GROUP MEDICARE DME PTAN
TN
01
—
0487990010
MAYNARDVILLE GROUP MEDICARE PTAN DME
TN
01
—
103I415299
MEDICARE PTAN
TN
01
—
12282
SUPERIOR VISION
—
01
—
1285860841
HUMANA
—
01
—
3941347
TN MEDICARE GROUP JACKSBORO
TN
05
—
3942271
—
TN
01
—
4247102
BCBSTN/BLUECARE/TENNCARE
TN
01
—
5668218
CIGNA
—
01
—
9356427
AETNA
—
01
—
P01993204
RR MEDICARE
TN
Enumeration date
06/09/2009
Last updated
03/31/2022
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