Provider Demographics
NPI:1467460550
Name:HUTSON, MARK F
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:HUTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4430
Mailing Address - Country:US
Mailing Address - Phone:512-261-0855
Mailing Address - Fax:
Practice Address - Street 1:2415 EXPOSITION BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2271
Practice Address - Country:US
Practice Address - Phone:512-477-2282
Practice Address - Fax:512-477-2336
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02320T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80481QOtherBLUE CROSS/BLUE SHIELD
TX00E80PMedicare ID - Type UnspecifiedMEDICARE
TX80481QOtherBLUE CROSS/BLUE SHIELD