Provider Demographics
NPI:1548278922
Name:MARSICH, MATTHEW MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:MARSICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 PERIMETER CTR N
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2405
Mailing Address - Country:US
Mailing Address - Phone:678-222-5228
Mailing Address - Fax:404-250-1477
Practice Address - Street 1:301 PERIMETER CTR N
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2405
Practice Address - Country:US
Practice Address - Phone:678-222-5228
Practice Address - Fax:404-250-1477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11391495OtherCAQH