Provider Demographics
NPI:1154931517
Name:MARVIN OPTOMETRY-MISSOURI, P.C.
Entity type:Organization
Organization Name:MARVIN OPTOMETRY-MISSOURI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-514-5268
Mailing Address - Street 1:1405 S HANLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2902
Mailing Address - Country:US
Mailing Address - Phone:314-652-3922
Mailing Address - Fax:314-207-6601
Practice Address - Street 1:1405 S HANLEY RD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2902
Practice Address - Country:US
Practice Address - Phone:314-703-9048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service