Provider Demographics
NPI:1770505232
Name:WOLFE, MARCI KAREN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCI
Middle Name:KAREN
Last Name:WOLFE
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 1:65 PLAZA 70 EAST
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-596-4416
Mailing Address - Fax:856-596-6566
Practice Address - Street 1:65 PLAZA 70 EAST
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-596-4416
Practice Address - Fax:856-596-6566
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJOAO4329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1C 0537910001OtherDME
NJ0537910001Medicare NSC
NJU26650Medicare UPIN
NJ421621TV2Medicare PIN
NJ421621Medicare PIN