Provider Demographics
NPI:1427029305
Name:KARSTEN, MARK ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:KARSTEN
Suffix:
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:989-354-5890
Mailing Address - Fax:989-356-6213
Practice Address - Street 1:224 E CHISHOLM ST STE A
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2820
Practice Address - Country:US
Practice Address - Phone:989-354-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900Z465100OtherBLUE CROSS
MIZ44509002Medicare PIN
MI900Z465100OtherBLUE CROSS
MI0302590001Medicare NSC