Provider Demographics
NPI:1104389352
Name:VETTIYIL, OOMMEN CHERIAN
Entity Type:Individual
Prefix:
First Name:OOMMEN
Middle Name:CHERIAN
Last Name:VETTIYIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17290 PRESTON RD STE 114
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-4027
Mailing Address - Country:US
Mailing Address - Phone:817-715-4266
Mailing Address - Fax:
Practice Address - Street 1:17290 PRESTON RD STE 114
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4027
Practice Address - Country:US
Practice Address - Phone:817-715-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies