Provider Demographics
NPI:1205028461
Name:SEVIGNY, MARK D (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SEVIGNY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:SEVIGNY & ASSOCIATES
Other - Middle Name:
Other - Last Name:EYE CARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DBA
Mailing Address - Street 1:735 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-2002
Mailing Address - Country:US
Mailing Address - Phone:863-773-3322
Mailing Address - Fax:863-773-6458
Practice Address - Street 1:735 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-2002
Practice Address - Country:US
Practice Address - Phone:863-773-3322
Practice Address - Fax:863-773-6458
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621295600Medicaid
FL621295600Medicaid
FL6147400001Medicare NSC