Healthcare Provider Details

I. General information

NPI: 1619957727
Provider Name (Legal Business Name): MARSHALL EYE CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14915 W MICHIGAN AVE
MARSHALL MI
49068-8504
US

IV. Provider business mailing address

14915 W MICHIGAN AVE
MARSHALL MI
49068-8504
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-9863
  • Fax:
Mailing address:
  • Phone: 269-781-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002507
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES E FLETCHER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 269-781-9863