Provider Demographics
NPI:1770674434
Name:MARHUE, BRIAN K (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:MARHUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 INTERNATIONAL CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7129
Mailing Address - Country:US
Mailing Address - Phone:239-768-0006
Mailing Address - Fax:239-768-0850
Practice Address - Street 1:6850 INTERNATIONAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7129
Practice Address - Country:US
Practice Address - Phone:239-768-0006
Practice Address - Fax:239-768-0850
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2542152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84859000Medicaid
FL20300Medicare PIN
FL84859000Medicaid