Provider Demographics
NPI:1558599621
Name:BULGER, MAVIS JO (OD)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:JO
Last Name:BULGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MAVIS
Other - Middle Name:JO
Other - Last Name:ARMBRUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1304 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4016
Mailing Address - Country:US
Mailing Address - Phone:314-920-7318
Mailing Address - Fax:
Practice Address - Street 1:1701 GALLERIA BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1602
Practice Address - Country:US
Practice Address - Phone:615-771-4908
Practice Address - Fax:615-771-7154
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5012152W00000X
TN3360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist