Provider Demographics
NPI:1134261746
Name:MARSHALL, DAN A (O D,)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:O D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ANCRUM RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2742
Mailing Address - Country:US
Mailing Address - Phone:803-432-7163
Mailing Address - Fax:803-432-7163
Practice Address - Street 1:1057 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2567
Practice Address - Country:US
Practice Address - Phone:803-299-0888
Practice Address - Fax:803-778-6896
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist