Provider Demographics
NPI:1063643591
Name:MARSHALL, BRYAN CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CRAIG
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 BEE CAVES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5536
Mailing Address - Country:US
Mailing Address - Phone:512-494-5350
Mailing Address - Fax:
Practice Address - Street 1:11500 BEE CAVES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5536
Practice Address - Country:US
Practice Address - Phone:512-494-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7376TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist