Provider Demographics
NPI:1912376377
Name:MARSHALL, DAVID JR (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5420
Mailing Address - Country:US
Mailing Address - Phone:440-942-3937
Mailing Address - Fax:
Practice Address - Street 1:7640 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5420
Practice Address - Country:US
Practice Address - Phone:440-942-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist