Provider Demographics
NPI:1356512719
Name:MARSHALL OPTICAL
Entity type:Organization
Organization Name:MARSHALL OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LO LICENSED OPTICIAN
Authorized Official - Phone:860-489-8999
Mailing Address - Street 1:881 NEW HARWINTON ROAD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-7208
Mailing Address - Country:US
Mailing Address - Phone:860-489-8999
Mailing Address - Fax:860-626-8117
Practice Address - Street 1:881 NEW HARWINTON ROAD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-7208
Practice Address - Country:US
Practice Address - Phone:860-489-8999
Practice Address - Fax:860-626-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00626156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
117159OtherEYEMED
CT100000626CT01OtherBLUE CROSS
0274850001Medicare NSC