Provider Demographics
NPI:1023182128
Name:PRICE, MARK O (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:O
Last Name:PRICE
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-0247
Mailing Address - Country:US
Mailing Address - Phone:559-732-0778
Mailing Address - Fax:559-732-5049
Practice Address - Street 1:812 W OAK AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6034
Practice Address - Country:US
Practice Address - Phone:559-732-0778
Practice Address - Fax:559-732-5049
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070340Medicaid
CASD0070340Medicaid
CASD0070340Medicaid
CAMP0645981OtherDEA CONTROLLED SUBSTANCE
CASD0070340Medicare PIN