Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C004911-1 | NY |
NPI | 1134160237 |
---|---|
Provider Name | Mr. Marc J. Demarco |
First Address | Fairport, NY 14450-1237 |
Second Address | Fairport, NY 14450-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 04/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260033487 | TAX I.D. (01) | NY |
8859 | EXCELLUS (01) | NY |