Martin Lee Waller II, LDO
Technician/Technologist, Optician in Hixson, TN. Individual provider (NPI-1).
NPI number1982111936
StatusActive
Last updated in NPPESDec 29, 2017
Details
- NPI
- 1982111936
- Entity type
- Individual (NPI-1)
- Name
- Martin Lee Waller II
- Credential
- LDO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 29, 2017
- Last updated
- Dec 29, 2017
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | DPO0000002824 | TN | Yes |
Practice location
5301 Highway 153Hixson, TN 37343-4966
Phone 423-877-9990
Mailing address
5301 Highway 153Hixson, TN 37343-4966
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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