Provider Demographics
NPI:1275581522
Name:MARSHALL, PAUL L (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:MARSHALL
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 1:2925 N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2006
Mailing Address - Country:US
Mailing Address - Phone:816-364-0450
Mailing Address - Fax:816-364-0487
Practice Address - Street 1:2925 N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2006
Practice Address - Country:US
Practice Address - Phone:816-364-0450
Practice Address - Fax:816-364-0487
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK551915Medicare ID - Type Unspecified
MOT98002Medicare UPIN