Provider Demographics
NPI:1568871309
Name:VETETO, MOLLIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:
Last Name:VETETO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MOLLIE
Other - Middle Name:
Other - Last Name:BROADWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:903 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6919
Mailing Address - Country:US
Mailing Address - Phone:575-437-7783
Mailing Address - Fax:575-439-0615
Practice Address - Street 1:903 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6919
Practice Address - Country:US
Practice Address - Phone:575-437-7783
Practice Address - Fax:575-439-0615
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5455152W00000X
COOPT0003356152W00000X
TN3363152W00000X
AR2704152W00000X
LA1789152W00000X
NMOPT717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist