Individual provider Active NPI

Nicole Ann Marshall, O.D.

  • Optometrist
  • Glen Allen, VA
National Provider Identifier
1164433892
Registry record updated Dec 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618000778 Issued in VA
Practice address
11369 Nuckols Rd
Glen Allen, VA 23059-5504
Phone
(804) 864-2020
Fax
(804) 377-8803
NPI assigned
Aug 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618000778 VA Primary

Addresses

Primary practice location

11369 Nuckols Rd
Glen Allen, VA 23059-5504

Mailing address

11369 Nuckols Rd
Glen Allen, VA 23059-5504
Phone (804) 864-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20170302001389 VA Practitioner - Optometry 7113201591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Virginia, PLLCGroup PAC ID 0143448456, 133 clinicians

Practice addresses (Care Compare)

12241 W Broad St
Suite C
Henrico, VA 23233-1063
Phone (804) 864-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Virginia PLLC Optometrist Current Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist CurrentSince May 9, 2022 Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist CurrentSince May 9, 2022 Accepting new patients
Myeyedr Optometry of Virginia, PPLC Optometrist Past Accepting new patients

Locations

44727 Brimfield Dr
Ashburn, VA 20147
Phone (571) 385-4600

10225 Patriot Hwy
Fredericksburg, VA 22407
Phone (540) 891-2020

11369 Nuckols Rd
Glen Allen, VA 23059
Phone (804) 864-2020

12241 W Broad St
Ste C
Henrico, VA 23233
Phone (804) 864-2020

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 4

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": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481241600000",
    "number": "1164433892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11369 NUCKOLS RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595504",
            "telephone_number": "804-864-2020",
            "fax_number": "804-377-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11369 NUCKOLS RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595504",
            "telephone_number": "804-864-2020",
            "fax_number": "804-377-8803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "NICOLE",
        "middle_name": "ANN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2016-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

Verify at the official NPI Registry.