Provider Demographics
NPI:1306837687
Name:MARSHALL, JAMES LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEWIS
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 1:1003 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-2805
Mailing Address - Country:US
Mailing Address - Phone:704-983-2202
Mailing Address - Fax:704-982-2202
Practice Address - Street 1:1003 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-2805
Practice Address - Country:US
Practice Address - Phone:704-983-2202
Practice Address - Fax:704-982-2202
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909544Medicaid
NC09544OtherBCBS
NC0148400001Medicare NSC
NCT64857Medicare UPIN
NC246312Medicare ID - Type Unspecified