Provider Demographics
NPI:1336126937
Name:MARSHA LAWRENCE
Entity Type:Organization
Organization Name:MARSHA LAWRENCE
Other - Org Name:RX OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-377-0064
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:525 FRONT ST
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333
Mailing Address - Country:US
Mailing Address - Phone:724-377-0064
Mailing Address - Fax:724-377-2119
Practice Address - Street 1:525 FRONT ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:PA
Practice Address - Zip Code:15333
Practice Address - Country:US
Practice Address - Phone:724-377-0064
Practice Address - Fax:724-377-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018583860001Medicaid
PA0018583860001Medicaid