Provider Demographics
NPI:1114339355
Name:BALLARD, JOSEPH MARSHALL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARSHALL
Last Name:BALLARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5811 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-3416
Mailing Address - Country:US
Mailing Address - Phone:910-884-9922
Mailing Address - Fax:910-401-1329
Practice Address - Street 1:5811 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-3416
Practice Address - Country:US
Practice Address - Phone:910-884-9922
Practice Address - Fax:910-401-1329
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist