Provider Demographics
NPI:1982275806
Name:MYRICK, MARLY COLEMAN (OD)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:COLEMAN
Last Name:MYRICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3309 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6190
Mailing Address - Country:US
Mailing Address - Phone:931-484-4861
Mailing Address - Fax:931-484-1484
Practice Address - Street 1:1845 OLD YORK HWY E
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-3740
Practice Address - Country:US
Practice Address - Phone:931-422-8480
Practice Address - Fax:931-422-8481
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist