Provider Demographics
NPI:1578311932
Name:SIMPLIS-GOREE, MARLENA I (CVRT)
Entity type:Individual
Prefix:MRS
First Name:MARLENA
Middle Name:I
Last Name:SIMPLIS-GOREE
Suffix:
Gender:F
Credentials:CVRT
Other - Prefix:
Other - First Name:MARLENA
Other - Middle Name:
Other - Last Name:SIMPLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-0522
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD.
Practice Address - Street 2:ADVANCE LOW VISION CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73552255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind