MEDICARE: JOHN JOSEPH MARCIN OD

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	OPC2193	FL

General Provider Information

NPI Number	:	1619076742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH MARCIN OD

Provider Business Mailing Address
First Line	:	2330 N WICKHAM ROAD
Second Line	:	SUITE 2
City	:	MELBOURNE
State	:	FL
Zip	:	32935
Country	:	US
Telephone Number	:	321-242-2424
Fax Number	:	321-253-1277

Provider Business Practice Location Address
First Line	:	2330 N WICKHAM ROAD
Second Line	:	SUITE 2
City	:	MELBOURNE
State	:	FL
Zip	:	32935
Country	:	US
Telephone Number	:	321-242-2424
Fax Number	:	321-253-1277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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