Healthcare Provider Details

I. General information

NPI: 1659594224
Provider Name (Legal Business Name): JOHN B. MARSHALL OPTOMETRIST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S CHURTON ST
HILLSBOROUGH NC
27278-2509
US

IV. Provider business mailing address

320 S CHURTON ST
HILLSBOROUGH NC
27278-2509
US

V. Phone/Fax

Practice location:
  • Phone: 919-732-5000
  • Fax: 919-732-6855
Mailing address:
  • Phone: 919-732-5000
  • Fax: 919-732-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN BRYAN MARSHALL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 919-732-5000