MEDICARE: DR. MARIANNE HELENA SERBYN OD

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	OPT-002917	AZ

General Provider Information

NPI Number	:	1811851090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANNE HELENA SERBYN OD

Provider Business Mailing Address
First Line	:	19420 N 59TH AVE STE E525
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6883
Country	:	US
Telephone Number	:	602-962-4168
Fax Number	:

Provider Business Practice Location Address
First Line	:	19420 N 59TH AVE STE E525
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6883
Country	:	US
Telephone Number	:	602-962-4168
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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