Provider Demographics
NPI:1770871683
Name:MARX, ANGELA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:MARX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:CROTEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3455 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2147
Mailing Address - Country:US
Mailing Address - Phone:607-722-2020
Mailing Address - Fax:607-722-3937
Practice Address - Street 1:3455 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2147
Practice Address - Country:US
Practice Address - Phone:607-722-2020
Practice Address - Fax:607-722-3937
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist