Provider Demographics
NPI:1184774614
Name:MORBEN, MARCUS DONN (OD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:DONN
Last Name:MORBEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SPRING HILL DRAW
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8614
Mailing Address - Country:US
Mailing Address - Phone:651-730-4086
Mailing Address - Fax:651-730-1888
Practice Address - Street 1:8362 TAMARACK VLG
Practice Address - Street 2:#108
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3392
Practice Address - Country:US
Practice Address - Phone:651-730-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU11073Medicare UPIN