MEDICARE: DR. PAUL ALLEN MARNUL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0467574	IL
2	152W00000X	Optometrist	T006884-1	NY

General Provider Information

NPI Number	:	1447220470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ALLEN MARNUL O.D.

Provider Business Mailing Address
First Line	:	211 S STATE ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-2229
Country	:	US
Telephone Number	:	815-568-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 S STATE ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-2229
Country	:	US
Telephone Number	:	815-568-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/27/2017

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