Provider Demographics
NPI:1154468767
Name:MARTY J. MRACHEK OD LTD
Entity Type:Organization
Organization Name:MARTY J. MRACHEK OD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MRACHEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-255-8490
Mailing Address - Street 1:537 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5859
Mailing Address - Country:US
Mailing Address - Phone:701-255-8490
Mailing Address - Fax:701-255-9349
Practice Address - Street 1:537 S 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5859
Practice Address - Country:US
Practice Address - Phone:701-255-8490
Practice Address - Fax:701-255-9349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20865Medicare ID - Type Unspecified