Provider Demographics
NPI:1003933573
Name:DELGADO, MARK CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:DELGADO
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 1:11600 BANDERA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6806
Mailing Address - Country:US
Mailing Address - Phone:210-680-4107
Mailing Address - Fax:210-680-4108
Practice Address - Street 1:11600 BANDERA RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6806
Practice Address - Country:US
Practice Address - Phone:210-680-4107
Practice Address - Fax:210-680-4108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3775TG152W00000X
CO1349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG000E96L2Medicaid
TXG000E96L2Medicaid
TXT12979Medicare UPIN