MEDICARE: DR W E MARSHALL AND DR J C MARSHALL OPTOMETRISTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18001561B	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548308232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR W E MARSHALL AND DR J C MARSHALL OPTOMETRISTS INC

Provider Business Mailing Address
First Line	:	1990 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-5128
Country	:	US
Telephone Number	:	317-357-8534
Fax Number	:	317-322-7794

Provider Business Practice Location Address
First Line	:	1990 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-5128
Country	:	US
Telephone Number	:	317-357-8534
Fax Number	:	317-322-7794

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY C MARSHALL
Credential	:	O.D.
Telephone Number	:	317-357-8534

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	02/19/2008

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