Provider Demographics
NPI:1265817902
Name:MARSH, AMIE (O D)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:MIRANDA
Other - Last Name:GAITHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 18TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1856
Mailing Address - Country:US
Mailing Address - Phone:918-444-4000
Mailing Address - Fax:
Practice Address - Street 1:1001 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-7017
Practice Address - Country:US
Practice Address - Phone:918-444-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist