Provider Demographics
NPI:1497712871
Name:DELSMAN, MARK JAMES
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:DELSMAN
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 1:3068 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3034
Mailing Address - Country:US
Mailing Address - Phone:619-298-5524
Mailing Address - Fax:619-298-7175
Practice Address - Street 1:3068 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3034
Practice Address - Country:US
Practice Address - Phone:619-298-5524
Practice Address - Fax:619-298-7175
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7444T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD001540Medicaid
CAGSD001540Medicaid
CAOP7444Medicare PIN