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General NPI Number Information
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NPI Number | 1609214642
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Entity Type | Organization
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Legal Business Name | DR. MARC S. THALL OPTOMETRY, INC
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 10316 SEPULVEDA BLVD
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City | MISSION HILLS
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State | CA
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Zip | 91345-2422
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Country | US
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Telephone | 818-361-4020
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Fax |
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Provider Business Mailing Address
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Address Line | 10316 SEPULVEDA BLVD
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City | MISSION HILLS
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State | CA
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Zip | 91345-2422
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Country | US
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Telephone | 818-361-4020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRY
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Name | MARC STEWART THALL
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Credential | OD
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Telephone | 818-361-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT5607TPA
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License Number State | CA
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