Provider Demographics
NPI:1164551966
Name:BYERS, MARK B (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:BYERS
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 1:429 D ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5706
Mailing Address - Country:US
Mailing Address - Phone:530-742-1679
Mailing Address - Fax:530-742-1233
Practice Address - Street 1:429 D ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5706
Practice Address - Country:US
Practice Address - Phone:530-742-1679
Practice Address - Fax:530-742-1233
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11554T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU62123Medicare UPIN
CACA157871Medicare PIN