Provider Demographics
NPI:1982614368
Name:MARLEY, EUGENE W (OD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:W
Last Name:MARLEY
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 1:1517 TRAMMELL DR
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3828
Mailing Address - Country:US
Mailing Address - Phone:817-249-2285
Mailing Address - Fax:
Practice Address - Street 1:239 W JEFFERSON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4510
Practice Address - Country:US
Practice Address - Phone:214-943-7604
Practice Address - Fax:214-941-6451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3813T152W00000X
KY1098DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX839486OtherEYE MED ID NUMBER
TX81184EOtherBLUE CROSS BLUE SHIELD
TXMA360100OtherCLARITY VISION NUMBER
TX00E81SOtherBLUE CROSS BLUE SHIELD
TX451997OtherNVA
TX839486OtherEYE MED ID NUMBER
TXMA360100OtherCLARITY VISION NUMBER