Provider Demographics
NPI:1912995739
Name:MARSH, GERALD (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:MARSH
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 1:5852 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2903
Mailing Address - Country:US
Mailing Address - Phone:440-684-0800
Mailing Address - Fax:
Practice Address - Street 1:5852 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2903
Practice Address - Country:US
Practice Address - Phone:440-684-0800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2500/T549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T48705Medicare UPIN
MA0608271Medicare ID - Type Unspecified