Provider Demographics
NPI:1033300561
Name:MARK O. PRICE, O.D.
Entity Type:Organization
Organization Name:MARK O. PRICE, O.D.
Other - Org Name:PRICE & PRICE O.D.S
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:O
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-732-0778
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001290Medicaid
CASD0070340Medicaid
CASD0070340Medicaid
CA0528860001Medicare NSC
CAYYY49627YMedicare UPIN
CAYYY49627YMedicare PIN