Provider Demographics
NPI:1750333555
Name:MARCEV, JOHN RANDOLPH (MS, OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDOLPH
Last Name:MARCEV
Suffix:
Gender:M
Credentials:MS, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18516
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8460
Mailing Address - Country:US
Mailing Address - Phone:601-264-2006
Mailing Address - Fax:601-261-3063
Practice Address - Street 1:6117 U S HIGHWAY 98
Practice Address - Street 2:SUITE 20
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8654
Practice Address - Country:US
Practice Address - Phone:601-264-2006
Practice Address - Fax:601-264-9030
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03951894Medicaid
MS03951894Medicaid