Provider Demographics
NPI:1184897993
Name:MARRON, INC.
Entity type:Organization
Organization Name:MARRON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:VERNELL
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-732-2020
Mailing Address - Street 1:49 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2751
Mailing Address - Country:US
Mailing Address - Phone:804-732-2020
Mailing Address - Fax:804-732-0470
Practice Address - Street 1:49 MORTON AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2751
Practice Address - Country:US
Practice Address - Phone:804-732-2020
Practice Address - Fax:804-732-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000457332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA009230548Medicaid
VAVA009230548Medicaid
VA0876320001Medicare NSC