Basic Information
Provider Information
NPI: 1275737041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OATMAN
FirstName: TAMMY
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1950 OLD GALLOWS RD
Address2: SUITE 520
City: VIENNA
State: VA
PostalCode: 221823990
CountryCode: US
TelephoneNumber: 7038478899
FaxNumber: 7039910514
Practice Location
Address1: 5940 ROSWELL RD
Address2:  
City: ATLANTA
State: GA
PostalCode: 303284908
CountryCode: US
TelephoneNumber: 4048432020
FaxNumber: 4048432022
Other Information
ProviderEnumerationDate: 06/13/2007
LastUpdateDate: 04/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XOPT001986GAY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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