=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497783203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNDA JEAN SHEPARD-MARZIALE OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 08/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 570 PAMLICO PLZ
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27889-3337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-329-7025
-----------------------------------------------------
Fax | 252-948-0309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 PROVIDENCE PLACE
-----------------------------------------------------
City | CHOCOWINITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-384-0377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1558
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------