Provider Demographics
NPI:1295981017
Name:MARSHALL, JESSICA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:2130 STATE ROUTE 35
Mailing Address - Street 2:IN C/O LENS CRAFTERS
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-3116
Mailing Address - Country:US
Mailing Address - Phone:732-275-0010
Mailing Address - Fax:732-275-0010
Practice Address - Street 1:2130 STATE ROUTE 35
Practice Address - Street 2:IN C/O LENS CRAFTERS
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-3116
Practice Address - Country:US
Practice Address - Phone:732-275-0010
Practice Address - Fax:732-275-0010
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0071501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000461Medicare UPIN