Provider Demographics
NPI:1821184870
Name:JOHN J MARCIN & ASSOCIATES PA
Entity Type:Organization
Organization Name:JOHN J MARCIN & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-242-3333
Mailing Address - Street 1:2330 N WICKHAM RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8182
Mailing Address - Country:US
Mailing Address - Phone:321-253-3333
Mailing Address - Fax:321-253-1277
Practice Address - Street 1:2330 N WICKHAM RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8182
Practice Address - Country:US
Practice Address - Phone:321-253-3333
Practice Address - Fax:321-253-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OPC2193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1198800001Medicare NSC