Basic Information
| Provider Information | |||||||||
| NPI: | 1437892957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHA HOWARD OPTOMETRIC CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | SIGNAL HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907552132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624278285 | ||||||||
| FaxNumber: | 6613357766 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 E WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | SIGNAL HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907552132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624278285 | ||||||||
| FaxNumber: | 6613357766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2022 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | SANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6618437616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.