Individual
WILLIS C MAPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1245 MADISON AVE, MEMPHIS, TN 38104
(901) 722-3250
(901) 722-3347
Mailing address
1245 MADISON AVE, MEMPHIS, TN 38104
(901) 722-3250
(901) 722-3347
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2643
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2643
OD
TN
05
—
3947083
—
TN
Enumeration date
10/17/2006
Last updated
03/07/2023
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