Active NPI
Edward Thomas Marshaleck, O.D.
- Optometrist
- Penndel, PA
National Provider Identifier
1730140328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OEG000900
- Practice address
- 132 Bellevue Ave
Penndel, PA 19047-5256 - Phone
- (215) 752-3252
- Fax
- (215) 752-3252
- NPI assigned
- Mar 31, 2006
- 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 | OEG000900 | PA | Primary |
Addresses
Primary practice location
132 Bellevue Ave
Penndel, PA 19047-5256
Mailing address
PO Box 7203
Penndel, PA 19047-7203
Phone (215) 752-3252
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0546740 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100216000846 | PA | Practitioner - Optometry | 2062556913 | Practice locations: Penndel, PA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207267200000",
"number": "1730140328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7203",
"city": "PENNDEL",
"state": "PA",
"postal_code": "190477203",
"telephone_number": "215-752-3252",
"fax_number": "215-752-3252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "132 BELLEVUE AVE",
"city": "PENNDEL",
"state": "PA",
"postal_code": "190475256",
"telephone_number": "215-752-3252",
"fax_number": "215-752-3252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALECK",
"first_name": "EDWARD",
"middle_name": "THOMAS",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2008-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "OEG000900",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0546740",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Penndel, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.