Provider Demographics
NPI:1467511998
Name:RAHNER, MARK RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RAYMOND
Last Name:RAHNER
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 1:1165 S CAMINO DEL RIO STE 100
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6824
Mailing Address - Country:US
Mailing Address - Phone:970-247-8762
Mailing Address - Fax:970-385-4496
Practice Address - Street 1:1165 S CAMINO DEL RIO STE 100
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6824
Practice Address - Country:US
Practice Address - Phone:970-247-8762
Practice Address - Fax:970-385-4496
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF6213Medicare PIN
COT60766Medicare UPIN