Provider Demographics
NPI:1245281070
Name:MARXER, CAJETAN CORNEL (OD)
Entity type:Individual
Prefix:
First Name:CAJETAN
Middle Name:CORNEL
Last Name:MARXER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:C
Other - Middle Name:CORNEL
Other - Last Name:MARXER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:200 N MULLAN RD STE 118
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6827
Mailing Address - Country:US
Mailing Address - Phone:509-921-5706
Mailing Address - Fax:509-921-5706
Practice Address - Street 1:200 N MULLAN RD STE 118
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6827
Practice Address - Country:US
Practice Address - Phone:509-921-5706
Practice Address - Fax:509-921-5706
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1988TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020485Medicaid