Provider Demographics
NPI:1750506127
Name:COMBES, TABITHA D (OD)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:D
Last Name:COMBES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TUSCULUM BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4056
Mailing Address - Country:US
Mailing Address - Phone:423-639-8128
Mailing Address - Fax:423-798-9204
Practice Address - Street 1:1000 TUSCULUM BLVD STE 4
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4056
Practice Address - Country:US
Practice Address - Phone:423-639-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001640152W00000X
TN2681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618001640OtherLICENSE
VA014264D73Medicare PIN
VA0618001640OtherLICENSE