Provider Demographics
NPI:1265520357
Name:MARSH, ROBERT ARTHUR (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ARTHUR
Last Name:MARSH
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 CLUBHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4811
Mailing Address - Country:US
Mailing Address - Phone:516-378-7623
Mailing Address - Fax:
Practice Address - Street 1:18012 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1620
Practice Address - Country:US
Practice Address - Phone:718-380-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4807156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01449467Medicaid
NY0659390001Medicare ID - Type UnspecifiedMEDICARE EYEGLASSES
NY01449467Medicaid