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NPI Code Detail

MEDICARE: MARLON J. DEMERITT, OD, PA.

MEDICARE: MARLON J. DEMERITT, OD, PA.
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
1152W00000XOptometristOPC 3886FL

General Provider Information

NPI Number : 1992966345
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARLON J. DEMERITT, OD, PA.
Provider Business Mailing Address
First Line : 2250 NW 78TH AVE
Second Line : 104
City : PEMBROKE PINES
State : FL
Zip : 33024-0908
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2250 NW 78TH AVE
Second Line : 104
City : PEMBROKE PINES
State : FL
Zip : 33024-0908
Country : US
Telephone Number : 305-753-9987
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. MARLON DEMERITT
Credential : O.D.
Telephone Number : 305-753-9987
Provider Enumeration Date : 06/18/2008
Last Update Date : 06/18/2008

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