Provider Demographics
NPI:1548308232
Name:DR W E MARSHALL AND DR J C MARSHALL OPTOMETRISTS INC
Entity type:Organization
Organization Name:DR W E MARSHALL AND DR J C MARSHALL OPTOMETRISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-357-8534
Mailing Address - Street 1:1990 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-5128
Mailing Address - Country:US
Mailing Address - Phone:317-357-8534
Mailing Address - Fax:317-322-7794
Practice Address - Street 1:1990 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-5128
Practice Address - Country:US
Practice Address - Phone:317-357-8534
Practice Address - Fax:317-322-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001561B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDR42420Medicaid
IN0328620001Medicare NSC
IN424200Medicare PIN