Organization
RIOLAN MARBUN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RIOLAN J MARBUN OD (OPTOMETRIST)
(252) 985-1371
Entity
Organization
Contact information
Practice address
800 BRENT GLEN PT, NASHVILLE, TN 37211-7200
(615) 604-6101
Mailing address
PO BOX 7756, ROCKY MOUNT, NC 27804-0756
(252) 985-1371
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2354
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35900201
—
TN
01
—
35900202
MEDICAID GROUP #
TN
01
—
4146608
BCBS PROVIDER #
TN
Enumeration date
03/15/2007
Last updated
02/17/2009
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