Individual
MARSHALL H MERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
46 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
(208) 359-2020
(208) 359-2021
Mailing address
345 N 2ND E, STE 1, REXBURG, ID 83440-1603
(208) 359-2020
(208) 359-2021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP813
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015275
REGENCE BLUE SHIELD
ID
01
—
000010015276
REGENCE BLUE SHIELD
ID
05
—
002652200
—
ID
01
—
V3058
BLUE CROSS OF IDAHO
ID
01
—
V7261
BLUE CROSS OF IDAHO
ID
Enumeration date
10/12/2006
Last updated
03/20/2017
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