Provider Demographics
NPI:1780782623
Name:METCALF, MARJORIE A (OPTICIAN)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:A
Last Name:METCALF
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S APOPKA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4802
Mailing Address - Country:US
Mailing Address - Phone:352-344-2020
Mailing Address - Fax:352-344-2137
Practice Address - Street 1:213 S APOPKA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4802
Practice Address - Country:US
Practice Address - Phone:352-344-2020
Practice Address - Fax:352-344-2137
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4970156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD6171OtherBLUE CROSS BLUE SHIELD
FL5949090001Medicare PIN