Provider Demographics
NPI:1376538975
Name:FORGUES, MARK JULIAN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JULIAN
Last Name:FORGUES
Suffix:JR
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 1:152 RUSSELL ST.
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609
Mailing Address - Country:US
Mailing Address - Phone:508-754-2308
Mailing Address - Fax:508-795-3921
Practice Address - Street 1:152 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1910
Practice Address - Country:US
Practice Address - Phone:508-754-2308
Practice Address - Fax:508-795-3921
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist