Provider Demographics
NPI:1073606711
Name:DENMAN, MARK (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DENMAN
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 1:1948 BUCHHOLZER BLVD.
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310
Mailing Address - Country:US
Mailing Address - Phone:330-630-5070
Mailing Address - Fax:330-630-5070
Practice Address - Street 1:1948 BUCHHOLZER BLVD.
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310
Practice Address - Country:US
Practice Address - Phone:330-630-5070
Practice Address - Fax:330-630-5070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3340 T1497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT47319Medicare UPIN
OHDE 0499245Medicare ID - Type Unspecified