Provider Demographics
NPI:1134160237
Name:DEMARCO, MARC J
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:J
Last Name:DEMARCO
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 1:1157 FAIRPORT RD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1237
Mailing Address - Country:US
Mailing Address - Phone:585-586-9900
Mailing Address - Fax:585-586-7700
Practice Address - Street 1:1157 FAIRPORT RD.
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1237
Practice Address - Country:US
Practice Address - Phone:585-586-9900
Practice Address - Fax:585-586-7700
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004911-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY260033487OtherTAX I.D.
NY8859OtherEXCELLUS