Basic Information
| Provider Information | |||||||||
| NPI: | 1881686426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSH | ||||||||
| FirstName: | COLY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7638 STONEBROOK PKWY | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750341003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727121010 | ||||||||
| FaxNumber: | 9727121011 | ||||||||
| Practice Location | |||||||||
| Address1: | 7638 STONEBROOK PKWY | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750341003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727121010 | ||||||||
| FaxNumber: | 9727121011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 05423TG | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 05423TG | 01 | TX | TX OPTOMETRY BOARD | OTHER | J0116737 | 01 | TX | DPS REGISTRATION | OTHER | 83328E | 01 | TX | BCBS ID NUMBER | OTHER | 1881686426 | 01 | TX | NPI | OTHER | 1902852346 | 01 | TX | GROUP NPI | OTHER | 00E41Y | 01 | TX | GROUP MEDICARE PIN | OTHER | 1881686426 | 01 | TX | EHR INCENTIVE PROGRAM | OTHER | MM0576124 | 01 | TX | DEA REGISTRATION | OTHER |