Provider Demographics
NPI:1881686426
Name:MARSH, COLY D (OD)
Entity Type:Individual
Prefix:DR
First Name:COLY
Middle Name:D
Last Name:MARSH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7638 STONEBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1003
Mailing Address - Country:US
Mailing Address - Phone:972-712-1010
Mailing Address - Fax:972-712-1011
Practice Address - Street 1:7638 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1003
Practice Address - Country:US
Practice Address - Phone:972-712-1010
Practice Address - Fax:972-712-1011
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05423TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05423TGOtherTX OPTOMETRY BOARD
TXJ0116737OtherDPS REGISTRATION
TX83328EOtherBCBS ID NUMBER
TX1881686426OtherNPI
TX1902852346OtherGROUP NPI
TX00E41YOtherGROUP MEDICARE PIN
TX1881686426OtherEHR INCENTIVE PROGRAM
TXMM0576124OtherDEA REGISTRATION
TXMM0576124OtherDEA REGISTRATION
TXP00812490Medicare PIN
TX00E41YOtherGROUP MEDICARE PIN
TX1902852346OtherGROUP NPI