person
Mr. Maurise Gene Vandergriff SR., LDO
Optician in Cleveland, Tennessee
NPI 1427184019

Maurise Gene Vandergriff SR. is a Optician based in Cleveland, TN and is specialized in Optician. Maurise Gene Vandergriff SR. practices in Cleveland, TN and has the professional credentials of LDO. The NPI Number for Maurise Gene Vandergriff SR. is 1427184019 and holds a License No. DPO 319 (Tennessee).

The current practice location address for Maurise Gene Vandergriff SR. is 2415 Chambliss Ave Nw, Cleveland, TN and can be reached out via phone at 423-479-4397 and via fax at 423-476-2974. You can also correspond with Maurise Gene Vandergriff SR. through the mailing address at 2415 CHAMBLISS AVE NW, CLEVELAND, TN - 37311-3882 (mailing address contact number: 423-479-4397).

Location: 2415 Chambliss Ave Nw, Cleveland, TN, 37311-3882
person
Provider Profile Details
NPI Number
1427184019
Provider Name
Maurise Gene Vandergriff SR.
Credential
LDO
Provider Entity Type
Individual
Gender
Male
Address
2415 Chambliss Ave Nw, Cleveland, TN, 37311-3882
Phone Number
423-479-4397
Fax Number
423-476-2974
Provider Enumeration Date
02/26/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2002794 01 TN BLUE CROSS & BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
2415 Chambliss Ave Nw
City
State
Zip
37311-3882
Phone Number
423-479-4397
Fax Number
423-476-2974
person
Provider Business Mailing Address Details
Address
2415 Chambliss Ave Nw
City
State
Zip
37311-3882
Phone Number
423-479-4397
Fax Number
423-476-2974
person
Provider's Taxonomy Details 1
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Optician
Taxonomy
License No.
DPO 319 (Tennessee)
Definition
Definition to come...
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