Provider Demographics
NPI:1447356084
Name:BROOKS, MARCEL W (OD)
Entity type:Individual
Prefix:DR
First Name:MARCEL
Middle Name:W
Last Name:BROOKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37767 MARKET DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3188
Mailing Address - Country:US
Mailing Address - Phone:301-884-9973
Mailing Address - Fax:
Practice Address - Street 1:37767 MARKET DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3188
Practice Address - Country:US
Practice Address - Phone:301-884-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA0946152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS00145Medicare UPIN