Provider Demographics
NPI:1356066658
Name:MARSHALL, DANIEL C (LO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HOSPITAL HILL RD.
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069
Mailing Address - Country:US
Mailing Address - Phone:860-364-0878
Mailing Address - Fax:860-364-2284
Practice Address - Street 1:26 HOSPITAL HILL RD.
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069
Practice Address - Country:US
Practice Address - Phone:860-364-0878
Practice Address - Fax:860-364-2284
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001710156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician