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General NPI Number Information
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NPI Number | 1700245214
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Entity Type | Organization
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Legal Business Name | EUGENE W. MARLEY, O.D. PLLC
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 1517 TRAMMELL DR
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City | BENBROOK
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State | TX
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Zip | 76126-3828
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Country | US
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Telephone | 817-249-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 1517 TRAMMELL DR
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City | BENBROOK
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State | TX
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Zip | 76126-3828
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Country | US
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Telephone | 817-249-2285
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | EUGENE W. MARLEY
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Credential |
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Telephone | 817-249-2285
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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 | 3813T
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License Number State | TX
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