Individual
DR. BRANCE EDWIN HAGOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
215 W BROADWAY ST, SUITE A, ROGERSVILLE, TN 37857-3280
(423) 272-2345
(423) 272-3324
Mailing address
215 W BROADWAY ST, SUITE A, ROGERSVILLE, TN 37857-3280
(423) 272-2345
(423) 272-3324
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT001413
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3123779
BLUE CROSS
TN
05
—
3598321
—
TN
Enumeration date
06/16/2006
Last updated
01/18/2010
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