Individual provider Active NPI

Katherine Emge Marshall, O.D.

  • Optometrist
  • Tyler, TX
National Provider Identifier
1093099509
Registry record updated Oct 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7830T Issued in TX
Practice address
136 Shelley Dr
Tyler, TX 75701-8723
Phone
(903) 561-8686
NPI assigned
Oct 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7830T TX Primary

Addresses

Primary practice location

136 Shelley Dr
Tyler, TX 75701-8723

Mailing address

136 Shelley Dr
Tyler, TX 75701-8723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120815000161 TX Practitioner - Optometry 8123274727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Abc EyecareGroup PAC ID 0547619918, 3 clinicians

Practice addresses (Care Compare)

136 Shelley Dr
Tyler, TX 75701-8723
Phone (903) 561-8686

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7830TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Larry M Chism PC Optometrist CurrentSince Jul 9, 2012 Accepting new patients
Abc Eyecare Optometrist CurrentSince Aug 10, 2023 Accepting new patients

Locations

6801 S Broadway Ave
Ste 100
Tyler, TX 75703
Phone (903) 561-2000

136 Shelley Dr
Tyler, TX 75701
Phone (903) 561-8686

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317600000000",
    "number": "1093099509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 SHELLEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 SHELLEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018723",
            "telephone_number": "903-561-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "KATHERINE",
        "middle_name": "EMGE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-03",
        "last_updated": "2011-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7830T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.