Provider Demographics
NPI:1730468851
Name:GRIFFIN, TIFFANY MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MICHELLE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 TALL PINES WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4604
Mailing Address - Country:US
Mailing Address - Phone:318-773-3106
Mailing Address - Fax:
Practice Address - Street 1:1125 SHREVEPORT BARKSDALE HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2404
Practice Address - Country:US
Practice Address - Phone:318-861-8982
Practice Address - Fax:318-861-8982
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7848T152W00000X
TX7848TG152W00000X
LA1612-645T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist