Provider Demographics
NPI:1679629232
Name:MARUSICH, CAROL E (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:MARUSICH
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 1:4765 VILLAGE PLAZA LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6676
Mailing Address - Country:US
Mailing Address - Phone:541-342-3100
Mailing Address - Fax:541-342-6153
Practice Address - Street 1:4765 VILLAGE PLAZA LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6676
Practice Address - Country:US
Practice Address - Phone:541-342-3100
Practice Address - Fax:541-342-6153
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1551ATI152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229179Medicaid
ORR106478Medicare ID - Type Unspecified
ORT67884Medicare UPIN