Provider Demographics
NPI:1508177379
Name:MARQUARDT, TERRY N (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:N
Last Name:MARQUARDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8641 W FRANKLIN RD
Mailing Address - Street 2:FRANKLIN TOWNE PLAZA IV
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0632
Mailing Address - Country:US
Mailing Address - Phone:208-378-8989
Mailing Address - Fax:208-378-9225
Practice Address - Street 1:8641 W FRANKLIN RD
Practice Address - Street 2:FRANKLIN TOWNE PLAZA IV
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0632
Practice Address - Country:US
Practice Address - Phone:208-378-8989
Practice Address - Fax:208-378-9225
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDODP100204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist