Provider Demographics
NPI:1295929537
Name:MARQUISS, ROBIN (OP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MARQUISS
Suffix:
Gender:F
Credentials:OP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241769
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1769
Mailing Address - Country:US
Mailing Address - Phone:907-770-2380
Mailing Address - Fax:907-770-2325
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:SUITE 410
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4922
Practice Address - Country:US
Practice Address - Phone:907-456-7760
Practice Address - Fax:907-451-7184
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK169156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK0000WCPCXOtherMEDICARE GROUP NUMBER
AKOP01691Medicaid