Healthcare Provider Details

I. General information

NPI: 1467568634
Provider Name (Legal Business Name): MARSHALL ANDREW FIELD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 ROUTE 130 SOUTH
NORTH BRUNSWICK NJ
08902
US

IV. Provider business mailing address

1825 ROUTE 130 SOUTH
NORTH BRUNSWICK NJ
08902
US

V. Phone/Fax

Practice location:
  • Phone: 732-422-8200
  • Fax: 732-422-8204
Mailing address:
  • Phone: 732-422-8200
  • Fax: 732-422-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5254
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: