Provider Demographics
NPI:1528045945
Name:PALMER, MARK A (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PALMER
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 1:313 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-1224
Mailing Address - Country:US
Mailing Address - Phone:402-395-2627
Mailing Address - Fax:402-395-6255
Practice Address - Street 1:313 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1224
Practice Address - Country:US
Practice Address - Phone:402-395-2627
Practice Address - Fax:402-395-6255
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36770OtherBLUE CROSS BLUE SHIELD
NE47082635800Medicaid
NE47082635800Medicaid
NE272347Medicare ID - Type Unspecified