Active NPI
Dennis N Marshall, O.D., P.A.
- Optometrist
- Blackfoot, ID
National Provider Identifier
1477548220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ODP-652
- Practice address
- 1495 Parkway Dr Ste a
Blackfoot, ID 83221-1639 - Phone
- (208) 785-3063
- Fax
- (208) 782-1392
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODP-652 | ID | Primary |
Addresses
Primary practice location
1495 Parkway Dr Ste a
Blackfoot, ID 83221-1639
Mailing address
PO Box 40
Blackfoot, ID 83221-0040
Phone (208) 785-3063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001261500 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODP-652 | ID | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361750400000",
"number": "1477548220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832210040",
"telephone_number": "208-785-3063",
"fax_number": "208-782-1392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1495 PARKWAY DR STE A",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832211639",
"telephone_number": "208-785-3063",
"fax_number": "208-782-1392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "DENNIS",
"middle_name": "N",
"credential": "O.D., P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-19",
"last_updated": "2013-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ID",
"license": "ODP-652",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001261500",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blackfoot, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.