Individual
DENNIS N MARSHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D., P.A.
Contact information
Practice address
1495 PARKWAY DR STE A, BLACKFOOT, ID 83221-1639
(208) 785-3063
(208) 782-1392
Mailing address
PO BOX 40, BLACKFOOT, ID 83221-0040
(208) 785-3063
(208) 782-1392
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-652
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001261500
—
ID
Enumeration date
09/19/2005
Last updated
02/25/2013
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