Provider Demographics
NPI:1427201474
Name:LEVY-SCANLON, MARNI ALLISON (OD)
Entity Type:Individual
Prefix:DR
First Name:MARNI
Middle Name:ALLISON
Last Name:LEVY-SCANLON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 DAVE LYLE BLVD.
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730
Mailing Address - Country:US
Mailing Address - Phone:803-366-9404
Mailing Address - Fax:803-366-0251
Practice Address - Street 1:2377 DAVE LYLE BLVD.
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:803-366-9404
Practice Address - Fax:803-366-0251
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00513000152W00000X
SCSC1973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ277089Medicare PIN