Provider Demographics
NPI:1609450055
Name:MARSHALL FAMILY EYECARE PLLC
Entity Type:Organization
Organization Name:MARSHALL FAMILY EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARYLENE
Authorized Official - Middle Name:DOWELL
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-448-7362
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1109
Mailing Address - Country:US
Mailing Address - Phone:870-448-2233
Mailing Address - Fax:870-448-5006
Practice Address - Street 1:303 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650
Practice Address - Country:US
Practice Address - Phone:870-448-2233
Practice Address - Fax:870-448-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty