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Individual

SHAWN T SUSSMANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1124 E WEISGARBER RD STE 104, KNOXVILLE, TN 37909-2686
(865) 584-2127
Mailing address
PO BOX 100284, GAINESVILLE, FL 32610-0284
(352) 273-8778
(352) 273-7402

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC6391
FL
152W00000X
Optometrist
TN2032
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3944150
TN
01
4025051
BCBS
TN
Enumeration date
07/22/2005
Last updated
05/24/2024
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