Provider Demographics
NPI:1811089584
Name:VOSS, MARDA JO (OD)
Entity type:Individual
Prefix:
First Name:MARDA
Middle Name:JO
Last Name:VOSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:960 CALUMET LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3606
Mailing Address - Country:US
Mailing Address - Phone:314-972-1392
Mailing Address - Fax:
Practice Address - Street 1:10950 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4435
Practice Address - Country:US
Practice Address - Phone:314-388-9999
Practice Address - Fax:314-388-9990
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOTO3356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist