Provider Demographics
NPI:1831181437
Name:MARLER, PHILIP WAYNE (OD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:WAYNE
Last Name:MARLER
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 911
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-0911
Mailing Address - Country:US
Mailing Address - Phone:601-267-9351
Mailing Address - Fax:601-267-9004
Practice Address - Street 1:201 HWY 16 E
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051
Practice Address - Country:US
Practice Address - Phone:601-267-9351
Practice Address - Fax:601-267-9004
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS605152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5196240001OtherDMERC NUMBER
MSP00079224OtherRAILROAD MEDICARE
MS00880054Medicaid
MSU50851Medicare UPIN
MS00880054Medicaid