Provider Demographics
NPI:1508802067
Name:GENRE, MARNIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:
Last Name:GENRE
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 1:33 LEAD MINE RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9524
Mailing Address - Country:US
Mailing Address - Phone:504-606-1905
Mailing Address - Fax:
Practice Address - Street 1:1125 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2184
Practice Address - Country:US
Practice Address - Phone:315-788-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5324101YP2500X
LA1391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional