Provider Demographics
NPI:1770586687
Name:MARBERGER, JON L (OD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:L
Last Name:MARBERGER
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:PO BOX 429
Mailing Address - Street 2:2256 MT CARMEL AVE
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-0429
Mailing Address - Country:US
Mailing Address - Phone:215-576-1321
Mailing Address - Fax:215-886-6892
Practice Address - Street 1:2256 MOUNT CARMEL AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4610
Practice Address - Country:US
Practice Address - Phone:215-576-1321
Practice Address - Fax:215-886-6892
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA21183407558OtherBEECH STREET
PA277623OtherMAMSI
PA1957331OtherUNITED HEALTHCARE
PAJ48917OtherAMERIHEALTH OF PA
PA86526166OtherBCBS OF AL
PAEYEMEDOther116943
PA2263894OtherAETNA
PA86526166OtherBCBS OF AL
PAEYEMEDOther116943
PA1957331OtherUNITED HEALTHCARE