Provider Demographics
NPI:1992966345
Name:MARLON J. DEMERITT, OD, PA.
Entity type:Organization
Organization Name:MARLON J. DEMERITT, OD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMERITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-753-9987
Mailing Address - Street 1:2250 NW 78TH AVE
Mailing Address - Street 2:104
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-0908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 NW 78TH AVE
Practice Address - Street 2:104
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-0908
Practice Address - Country:US
Practice Address - Phone:305-753-9987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty