Vestal, Marietta T
Vestal, Marietta T is an sole proprietor health care provider with primary practice located at 910 Tusculum Blvd Ste 2, Greeneville TN 37745-4004. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Vestal, Marietta T can be contacted via phone (423) 639-2002.Contact Information
Primary practice address
910 Tusculum Blvd Ste 2
Greeneville TN 37745-4004
Phone: (423) 639-2002
Fax: (423) 638-4522
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OD0000000490 | Tennessee |
Profile Details
| NPI number | 1992786420 |
|---|---|
| LBN Legal business name | Vestal, Marietta T |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 10th, 2005 |
| Last updated | Jan 16th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992786420 | NPPES |
| Tennessee | MEDICAID | 3593480 |
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