MEDICARE: DR. JOSEPH T. MARRA 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	152WC0802X	Corneal and Contact Management Optometrist	4212	OH
2	152WP0200X	Pediatric Optometrist	4212	OH

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	:	1831194869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH T. MARRA OD

Provider Business Mailing Address
First Line	:	4240 SECOR ROAD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4238
Country	:	US
Telephone Number	:	419-475-6605
Fax Number	:	419-475-2017

Provider Business Practice Location Address
First Line	:	4240 SECOR ROAD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4238
Country	:	US
Telephone Number	:	419-475-6605
Fax Number	:	419-475-2017

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/27/2015

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