Provider Demographics
NPI:1487838082
Name:MARK S. FEDER, O.D.
Entity Type:Organization
Organization Name:MARK S. FEDER, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:FEDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-853-1010
Mailing Address - Street 1:5 EVERSLEY AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5821
Mailing Address - Country:US
Mailing Address - Phone:203-853-1010
Mailing Address - Fax:203-866-0767
Practice Address - Street 1:5 EVERSLEY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5821
Practice Address - Country:US
Practice Address - Phone:203-853-1010
Practice Address - Fax:203-866-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0177510001Medicare NSC