Provider Demographics
NPI:1255770772
Name:FERRELL, GREGORY V (OD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:V
Last Name:FERRELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4143
Mailing Address - Country:US
Mailing Address - Phone:740-387-8414
Mailing Address - Fax:740-382-9437
Practice Address - Street 1:399 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4143
Practice Address - Country:US
Practice Address - Phone:740-387-8414
Practice Address - Fax:740-382-9434
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist