Provider Demographics
NPI:1366420267
Name:STEELE, KURT T (OD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:T
Last Name:STEELE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 CROWE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-7264
Mailing Address - Country:US
Mailing Address - Phone:423-623-3875
Mailing Address - Fax:423-623-2977
Practice Address - Street 1:1823 CROWE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7264
Practice Address - Country:US
Practice Address - Phone:423-623-3875
Practice Address - Fax:423-623-2977
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3590667Medicaid
TN1598745564OtherGROUP NPI
MS0203036OtherDEA NUMBER
TN3940475Medicare PIN
U61429Medicare UPIN
MS0203036OtherDEA NUMBER