MEDICARE: AVERA MARSHALL

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

General Provider Information

NPI Number	:	1760740567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MARSHALL

Provider Business Mailing Address
First Line	:	300 S BRUCE ST
Second Line	:
City	:	MARSHALL
State	:	MN
Zip	:	56258-1934
Country	:	US
Telephone Number	:	507-532-9661
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 N 3RD ST
Second Line	:
City	:	MARSHALL
State	:	MN
Zip	:	56258-1324
Country	:	US
Telephone Number	:	507-532-5143
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEBBIE STREIER
Credential	:
Telephone Number	:	507-537-9160

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	12/02/2022

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Directions to “AVERA MARSHALL ” Practice Location

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