Individual
MARIETTA T VESTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
910 TUSCULUM BLVD, STE 2, GREENEVILLE, TN 37745-4004
(423) 639-2002
(423) 638-4522
Mailing address
910 TUSCULUM BLVD, STE 2, GREENEVILLE, TN 37745-4004
(423) 639-2002
(423) 638-4522
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD0000000490
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3593480
—
TN
Enumeration date
11/10/2005
Last updated
01/16/2008
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