Provider Demographics
NPI:1174853824
Name:MARK A PLUMB OD PA
Entity Type:Organization
Organization Name:MARK A PLUMB OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PLUMB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-596-9775
Mailing Address - Street 1:10652 OLD HAMMOCK WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3148
Mailing Address - Country:US
Mailing Address - Phone:561-795-8833
Mailing Address - Fax:
Practice Address - Street 1:10652 OLD HAMMOCK WAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3148
Practice Address - Country:US
Practice Address - Phone:561-795-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDI028AMedicare PIN
FLU58001Medicare UPIN