Provider Demographics
NPI:1407698889
Name:WISE, MARCUS LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:LAWRENCE
Last Name:WISE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:15 JANE JACOBS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-6307
Mailing Address - Country:US
Mailing Address - Phone:828-669-1191
Mailing Address - Fax:828-669-6024
Practice Address - Street 1:15 JANE JACOBS RD STE 103
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6307
Practice Address - Country:US
Practice Address - Phone:828-669-1191
Practice Address - Fax:828-669-6024
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-09-03
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Provider Licenses
StateLicense IDTaxonomies
NC2836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist