Provider Demographics
NPI:1629194451
Name:MARLEY, CHARLES N (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:N
Last Name:MARLEY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 HILL LN
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1540
Mailing Address - Country:US
Mailing Address - Phone:856-305-1389
Mailing Address - Fax:856-825-4242
Practice Address - Street 1:1101 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2539
Practice Address - Country:US
Practice Address - Phone:856-825-4242
Practice Address - Fax:856-825-4242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD0006350156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5950460001Medicare NSC