NPIMap

Organization Active NPI

Mark R. Kapperman, OD PC

  • Optometrist
  • Chattanooga, TN
National Provider Identifier
1821125485
Registry record updated Jun 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
001120-TNOD Issued in TN
Legal business name
MARK R. KAPPERMAN, OD PC
Practice address
1720 Gunbarrel Rd Ste 100
Chattanooga, TN 37421-3192
Phone
(423) 892-2020
Fax
(423) 855-0329
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark R. Kapperman, ODNPI 1295728863
Title
President
Phone
(423) 892-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 001120-TNOD TN Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 001996 TN

Addresses

Primary practice location

1720 Gunbarrel Rd Ste 100
Chattanooga, TN 37421-3192

Mailing address

1720 Gunbarrel Rd Ste 100
Chattanooga, TN 37421-3192
Phone (423) 892-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071113000070 TN Part B Supplier - Clinic/Group Practice 2769570571 Receives reassigned benefits from 6 practitioners
Practice locations: Chattanooga, TN
O20100930055768 TN DME Supplier - Physician - Optometrist 2769570571 Practice locations: Chattanooga, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2086533Mark Kapperman OD PC1720 Gunbarrel Rd, Ste 100, Chattanooga, TN 37421Certificate of waiverNov 4, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mark R. Kapperman, OD PC1720 Gunbarrel Rd, Chattanooga, TN 37421-3192(423) 892-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Nov 19, 1999

National Provider Directory

National Provider Directory

Locations

1720 Gunbarrel Rd
Ste 100
Chattanooga, TN 37421
Phone (423) 832-2020

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1821125485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 GUNBARREL RD STE 100",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374213192",
            "telephone_number": "423-892-2020",
            "fax_number": "423-855-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 GUNBARREL RD STE 100",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374213192",
            "telephone_number": "423-892-2020",
            "fax_number": "423-855-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK R. KAPPERMAN, OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "KAPPERMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-892-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "001120-TNOD",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "001996",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.