Cleveland Optical Dispensary, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

DPO636 Issued in TN

Legal business name

CLEVELAND OPTICAL DISPENSARY, INC.

Practice address

2415 Chambliss Ave NW
Cleveland, TN 37311-3882

Phone

(423) 479-4397

Fax

(423) 476-2974

NPI assigned

Jan 28, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Maurise Gene Vandergriff Sr., L.D.O.

Title

Owner

Phone

(423) 479-4397

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1760669147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 CHAMBLISS AVE NW",
            "address_2": "P.O. BOX 2728",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113882",
            "telephone_number": "423-479-4397",
            "fax_number": "423-476-2974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 CHAMBLISS AVE NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113882",
            "telephone_number": "423-479-4397",
            "fax_number": "423-476-2974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND OPTICAL DISPENSARY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "VANDERGRIFF",
        "authorized_official_first_name": "MAURISE",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-479-4397",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "L.D.O."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "TN",
            "license": "DPO636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cleveland Medical Associates, PLLC
• Cleveland Medical Clinic Inc
• Cleveland Medical Clinic Inc
• Cleveland Medical Clinic Inc
• Cleveland Non-Surgical PC
• Cleveland Pain Management, PC
• Cleveland Pain Medicine, PLLC
• Cleveland Pediatrics,P.C.
• Cleveland Physical Therapy, Inc.
• Cleveland Psychiatric Center, PC

• Eyewear Supplier in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Eyewear Supplier in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.