Provider Demographics
NPI:1366552663
Name:DR J J MARSH LTD
Entity type:Organization
Organization Name:DR J J MARSH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-426-2020
Mailing Address - Street 1:2510 W. 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-4907
Mailing Address - Country:US
Mailing Address - Phone:920-426-2020
Mailing Address - Fax:920-235-3195
Practice Address - Street 1:2510 W. 9TH AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-4907
Practice Address - Country:US
Practice Address - Phone:920-426-2020
Practice Address - Fax:920-235-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2161OtherSTATE LICENSE
WI38529700Medicaid
WI000071124Medicare PIN
WI2161OtherSTATE LICENSE
WI0581850001Medicare NSC