Provider Demographics
NPI:1154328821
Name:MARCUS, JILL A (OD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:MARCUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MANETTO HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1324
Mailing Address - Country:US
Mailing Address - Phone:516-942-4400
Mailing Address - Fax:
Practice Address - Street 1:146 MANETTO HILL RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1324
Practice Address - Country:US
Practice Address - Phone:516-942-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005956-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC58551Medicare ID - Type Unspecified
NYU76062Medicare UPIN