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Individual
DR. MARC STEWART THALL
Active
Individual
DR. MARC STEWART THALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPT 5607 TPA
CA
152W00000X
Optometrist
Primary
OPT5607TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3992
MESC
—
01
—
56-2563452
USP
—
05
—
SD0056070
—
CA
Enumeration date
09/11/2006
Last updated
06/05/2013
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