Provider Demographics
NPI:1275819849
Name:GURVICH, MARINA L (OD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:L
Last Name:GURVICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:L
Other - Last Name:GORENSHTEYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:991 PEACHTREE INDUSTRIAL BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4343
Mailing Address - Country:US
Mailing Address - Phone:770-904-0883
Mailing Address - Fax:678-765-0976
Practice Address - Street 1:991 PEACHTREE INDUSTRIAL BLVD STE 114
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4343
Practice Address - Country:US
Practice Address - Phone:770-904-0883
Practice Address - Fax:678-765-0976
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I412734Medicare PIN