Provider Demographics
NPI:1275537961
Name:MARK, ADAM DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:MARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:935 HWY 34
Mailing Address - Street 2:STE 1A
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3282
Mailing Address - Country:US
Mailing Address - Phone:732-583-9797
Mailing Address - Fax:732-583-3634
Practice Address - Street 1:935 ROUTE 34
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3283
Practice Address - Country:US
Practice Address - Phone:732-583-9797
Practice Address - Fax:732-583-3634
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00560700152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46169MAPMedicare ID - Type Unspecified
NJU77365Medicare UPIN