Provider Demographics
NPI:1851712384
Name:DALY, MARSHALL ALLAN
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:ALLAN
Last Name:DALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1735
Mailing Address - Country:US
Mailing Address - Phone:763-390-6268
Mailing Address - Fax:763-390-5038
Practice Address - Street 1:2484 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1735
Practice Address - Country:US
Practice Address - Phone:763-390-6268
Practice Address - Fax:763-390-5038
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician