Provider Demographics
NPI:1801479068
Name:VAZHAPPILLY, SHERENE THERESA
Entity type:Individual
Prefix:
First Name:SHERENE
Middle Name:THERESA
Last Name:VAZHAPPILLY
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 1:7800 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4388
Mailing Address - Country:US
Mailing Address - Phone:513-793-5970
Mailing Address - Fax:
Practice Address - Street 1:5220 JIMMY LEE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2739
Practice Address - Country:US
Practice Address - Phone:770-439-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT003546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist