Provider Demographics
NPI:1306924386
Name:MEADOWS, MARCUS LAVELLE (OD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:LAVELLE
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3203 ABACUS CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3883
Mailing Address - Country:US
Mailing Address - Phone:301-464-0178
Mailing Address - Fax:410-863-1292
Practice Address - Street 1:6721 CHESAPEAKE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060
Practice Address - Country:US
Practice Address - Phone:410-863-1290
Practice Address - Fax:410-863-1292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020581860Medicaid