Provider Demographics
NPI:1740473321
Name:MARSHALL, EVERETT F (OD)
Entity type:Individual
Prefix:
First Name:EVERETT
Middle Name:F
Last Name:MARSHALL
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 1:241 N COURT ST APT H
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-2593
Mailing Address - Country:US
Mailing Address - Phone:343-387-0500
Mailing Address - Fax:334-387-0505
Practice Address - Street 1:241 N COURT ST APT H
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-2593
Practice Address - Country:US
Practice Address - Phone:334-387-0500
Practice Address - Fax:334-387-0505
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSB61TA760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL153256Medicaid
AL009913952Medicaid
AL529900280Medicaid