Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3245 | TN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3245 | TN |
N | 152WP0200X | Pediatric Optomitrist | 3245 | TN |
N | 152WS0006X | Sports Vision | 3245 | TN |
N | 152WV0400X | Optomitrist - Vision Therapist | 3245 | TN |
NPI | 1003297318 |
---|---|
Provider Name | Dr. Virgilio P Gozum |
First Address | Spring Hill, TN 37174-2443 |
Second Address | Spring Hill, TN 37174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 21/06/2018 |