Provider Demographics
NPI:1043438666
Name:HANDMACHER, MARK DAVID
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:HANDMACHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W. WASHINGTON ST.
Mailing Address - Street 2:INSIGHT OPTICAL CENTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-291-3937
Mailing Address - Fax:619-291-3937
Practice Address - Street 1:325 W. WASHINGTON ST.
Practice Address - Street 2:INSIGHT OPTICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-291-3937
Practice Address - Fax:619-291-3937
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 3439156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0164700001Medicare NSC