Provider Demographics
NPI:1194851774
Name:MARK FROMER, MD PC
Entity Type:Organization
Organization Name:MARK FROMER, MD PC
Other - Org Name:FROMER EYE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-832-9228
Mailing Address - Street 1:3130 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1213
Mailing Address - Country:US
Mailing Address - Phone:718-741-3200
Mailing Address - Fax:
Practice Address - Street 1:3130 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1213
Practice Address - Country:US
Practice Address - Phone:718-741-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W7Z642Medicare PIN