Provider Demographics
NPI:1902257413
Name:MARSO, NICHOLAS (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MARSO
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 1:640 E SIOUX AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3300
Mailing Address - Country:US
Mailing Address - Phone:605-224-6128
Mailing Address - Fax:605-224-8446
Practice Address - Street 1:640 E SIOUX AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3300
Practice Address - Country:US
Practice Address - Phone:605-224-6128
Practice Address - Fax:605-224-8446
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist