Provider Demographics
NPI:1871262501
Name:MARVEL VISION CLINIC, LLC
Entity Type:Organization
Organization Name:MARVEL VISION CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVODA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-961-9611
Mailing Address - Street 1:239 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2503
Mailing Address - Country:US
Mailing Address - Phone:406-961-9611
Mailing Address - Fax:
Practice Address - Street 1:239 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2503
Practice Address - Country:US
Practice Address - Phone:406-961-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty