Individual
DR. MARSHALL PERRY TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
812 W WADE HAMPTON BLVD, GREER, SC 29650-1309
(864) 877-1825
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2109
MN
152W00000X
Optometrist
Primary
2303
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15952
SPECTERA
MN
01
—
22-01918
MEDICA
MN
01
—
333471032669
PREFERRED ONE
MN
05
—
478523100
—
MN
01
—
48379
DAVIS VISION
MN
01
—
52M69TI
BLUE CROSS
MN
Enumeration date
08/29/2006
Last updated
08/25/2022
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