Basic Information
| Provider Information | |||||||||
| NPI: | 1790755544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | JUNEAN | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 RED LION RD | ||||||||
| Address2: | APT I 10 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191151246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159693443 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2842 S EAGLE RD | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155791155 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG001734 | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.