Provider Demographics
NPI:1790755544
Name:MARSHALL, JUNEAN (OD)
Entity Type:Individual
Prefix:
First Name:JUNEAN
Middle Name:
Last Name:MARSHALL
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 1:600 RED LION RD
Mailing Address - Street 2:APT I 10
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1246
Mailing Address - Country:US
Mailing Address - Phone:215-969-3443
Mailing Address - Fax:
Practice Address - Street 1:2842 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1543
Practice Address - Country:US
Practice Address - Phone:215-579-1155
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist