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General NPI Number Information
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NPI Number | 1750333555
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Entity Type | Individual
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Provider Name | JOHN RANDOLPH MARCEV M.S., O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 6117 U S HIGHWAY 98 SUITE 20
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City | HATTIESBURG
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State | MS
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Zip | 39402-8654
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Country | US
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Telephone | 601-264-2006
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Fax | 601-264-9030
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Provider Business Mailing Address
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Address Line | PO BOX 18516
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City | HATTIESBURG
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State | MS
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Zip | 39404-8460
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Country | US
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Telephone | 601-264-2006
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Fax | 601-261-3063
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 690
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License Number State | MS
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