Provider Demographics
NPI:1164685947
Name:HOWELL, MARVIN ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ANTHONY
Last Name:HOWELL
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 1:4101 ROSWELL RD
Mailing Address - Street 2:SUITE 905
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6293
Mailing Address - Country:US
Mailing Address - Phone:770-565-3970
Mailing Address - Fax:
Practice Address - Street 1:4101 ROSWELL RD
Practice Address - Street 2:SUITE 905
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6293
Practice Address - Country:US
Practice Address - Phone:770-565-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002629152W00000X, 152WP0200X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125145CMedicaid