Provider Demographics
NPI:1376349068
Name:MARSOLO, LAURIE CROFF (LDO)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:CROFF
Last Name:MARSOLO
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 RIVERSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2918
Mailing Address - Country:US
Mailing Address - Phone:770-720-1023
Mailing Address - Fax:770-479-3403
Practice Address - Street 1:1550 RIVERSTONE PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2918
Practice Address - Country:US
Practice Address - Phone:770-720-1023
Practice Address - Fax:770-479-3403
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001846156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician