MEDICARE: OOMMEN CHERIAN VETTIYIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1104389352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OOMMEN CHERIAN VETTIYIL

Provider Business Mailing Address
First Line	:	17290 PRESTON RD STE 114
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-4027
Country	:	US
Telephone Number	:	817-715-4266
Fax Number	:

Provider Business Practice Location Address
First Line	:	17290 PRESTON RD STE 114
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-4027
Country	:	US
Telephone Number	:	817-715-4266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	04/12/2019

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