Provider Demographics
NPI:1548283203
Name:PALMER, MARCIA J (OD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:J
Last Name:PALMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N EL CAMINO REAL
Mailing Address - Street 2:#303
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3738
Mailing Address - Country:US
Mailing Address - Phone:650-685-6303
Mailing Address - Fax:
Practice Address - Street 1:801 N EL CAMINO REAL
Practice Address - Street 2:#303
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3738
Practice Address - Country:US
Practice Address - Phone:650-685-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH5293152W00000X
CA13228T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2636080Medicaid
OHBU4121271Medicare ID - Type Unspecified
BU4121273Medicare ID - Type Unspecified
OHBU4121272Medicare ID - Type Unspecified
OH2636080Medicaid