Basic Information
| Provider Information | |||||||||
| NPI: | 1003297318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOZUM | ||||||||
| FirstName: | VIRGILIO | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5238 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371742443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314891950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5238 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314891950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WV0400X | 3245 | TN | N | Eye and Vision Services Providers | Optometrist | Vision Therapy | 152W00000X | 3245 | TN | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | 3245 | TN | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | 3245 | TN | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152WS0006X | 3245 | TN | N | Eye and Vision Services Providers | Optometrist | Sports Vision |
No ID Information.