Provider Demographics
NPI:1619585130
Name:MISCH, CAROLINE VOLLBERG (OD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:VOLLBERG
Last Name:MISCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4511 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5067
Mailing Address - Country:US
Mailing Address - Phone:423-870-3742
Mailing Address - Fax:423-877-9494
Practice Address - Street 1:4511 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5067
Practice Address - Country:US
Practice Address - Phone:423-870-3742
Practice Address - Fax:423-877-9494
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist