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General NPI Number Information
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NPI Number | 1104487966
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Entity Type | Individual
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Provider Name | BREANNA JO SCOTT MARKER OD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 4200 W COUNTY ROAD 42
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City | SAVAGE
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State | MN
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Zip | 55378-4051
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Country | US
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Telephone | 952-895-5434
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Fax |
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Provider Business Mailing Address
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Address Line | 518 FRANKLIN ST
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City | PELLA
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State | IA
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Zip | 50219-1636
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Country | US
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Telephone | 641-628-2023
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Fax | 641-628-2031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 096551
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 096551
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License Number State | IA
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