Provider Demographics
NPI:1144219353
Name:COONEY, MARK D (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:COONEY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8055 WEST AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1841
Mailing Address - Country:US
Mailing Address - Phone:210-340-1919
Mailing Address - Fax:210-348-0348
Practice Address - Street 1:8055 WEST AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1841
Practice Address - Country:US
Practice Address - Phone:210-340-1919
Practice Address - Fax:210-348-0348
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX3121T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E99KMedicare ID - Type UnspecifiedLOCAL PART B