Provider Demographics
NPI:1083963466
Name:DIMARTINO, ADDISON (OD)
Entity Type:Individual
Prefix:DR
First Name:ADDISON
Middle Name:
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:
Other - Last Name:LUPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 EMORY DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745
Mailing Address - Country:US
Mailing Address - Phone:423-683-4151
Mailing Address - Fax:423-639-6861
Practice Address - Street 1:204 EMORY DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745
Practice Address - Country:US
Practice Address - Phone:423-683-4151
Practice Address - Fax:423-639-6861
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist