Individual
MARTIN LEE WALLER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
5301 HIGHWAY 153, HIXSON, TN 37343-4966
(423) 877-9990
Mailing address
5301 HIGHWAY 153, HIXSON, TN 37343-4966
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DPO0000002824
TN
Other
Enumeration date
12/29/2017
Last updated
12/29/2017
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