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General NPI Number Information
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NPI Number | 1659675270
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Entity Type | Organization
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Legal Business Name | MARSHALL EYECARE PHYSICIANS, PC
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 2128 STATE ROUTE 35
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City | HOLMDEL
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State | NJ
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Zip | 07733-2742
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Country | US
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Telephone | 732-275-0010
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Fax |
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Provider Business Mailing Address
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Address Line | 2128 STATE ROUTE 35
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City | HOLMDEL
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State | NJ
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Zip | 07733-2742
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Country | US
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Telephone | 732-275-0010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA L MARSHALL
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Credential | OD
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Telephone | 732-275-0010
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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 | 27OA00624800
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License Number State | NJ
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