Provider Demographics
NPI:1598591216
Name:MARSHALL, ANDREW KEIICHI (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:KEIICHI
Last Name:MARSHALL
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 1:2751 MAINWAY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4724
Mailing Address - Country:US
Mailing Address - Phone:562-400-1474
Mailing Address - Fax:
Practice Address - Street 1:28901 S WESTERN AVE STE 129
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0824
Practice Address - Country:US
Practice Address - Phone:310-221-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist