Provider Demographics
NPI:1962858373
Name:GRIFFITH, DANNI
Entity Type:Individual
Prefix:
First Name:DANNI
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4714
Mailing Address - Country:US
Mailing Address - Phone:541-747-1120
Mailing Address - Fax:541-757-9741
Practice Address - Street 1:130 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4714
Practice Address - Country:US
Practice Address - Phone:541-747-1120
Practice Address - Fax:541-757-9741
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OR3662ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program