Provider Demographics
NPI:1588614960
Name:DAY, MARSHALL PATRICK (OD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:PATRICK
Last Name:DAY
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0606
Mailing Address - Country:US
Mailing Address - Phone:580-323-5421
Mailing Address - Fax:866-585-2957
Practice Address - Street 1:565 S 30TH STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-323-5421
Practice Address - Fax:866-585-2957
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763130AMedicaid
OK731048669Medicare PIN
826580316Medicare ID - Type UnspecifiedRAILROAD