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General NPI Number Information
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NPI Number | 1154931517
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Entity Type | Organization
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Legal Business Name | MARVIN OPTOMETRY-MISSOURI, P.C.
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 1405 S HANLEY RD STE B
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City | SAINT LOUIS
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State | MO
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Zip | 63144-2902
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Country | US
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Telephone | 314-703-9048
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 S HANLEY RD STE B
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City | SAINT LOUIS
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State | MO
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Zip | 63144-2902
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Country | US
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Telephone | 314-652-3922
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Fax | 314-207-6601
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. ASHLEY MARVIN
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Credential | OD
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Telephone | 618-514-5268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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