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General NPI Number Information
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NPI Number | 1801803044
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Entity Type | Individual
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Provider Name | TERRY TYRONE MARQUARDT OD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 903 NEW YORK AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6919
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Country | US
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Telephone | 575-437-7783
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Fax | 575-439-0615
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Provider Business Mailing Address
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Address Line | 903 NEW YORK AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6919
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Country | US
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Telephone | 575-437-7783
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Fax | 575-439-0615
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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 | 233
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 05843TG
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License Number State | TX
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