Provider Demographics
NPI:1154365542
Name:MARCEV, DEBORAH J (OD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:MARCEV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-9272
Mailing Address - Country:US
Mailing Address - Phone:601-261-6167
Mailing Address - Fax:
Practice Address - Street 1:3901 HARDY ST
Practice Address - Street 2:STE. 130
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1636
Practice Address - Country:US
Practice Address - Phone:601-261-3383
Practice Address - Fax:601-268-5515
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880226Medicaid
MSU94139Medicare UPIN