Provider Demographics
NPI:1548233364
Name:SVERDLIN, MARK ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ERIC
Last Name:SVERDLIN
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 1:255 HIGHWAY 35 NORTH
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2103
Mailing Address - Country:US
Mailing Address - Phone:732-389-6512
Mailing Address - Fax:
Practice Address - Street 1:255 HIGHWAY 35 NORTH
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2103
Practice Address - Country:US
Practice Address - Phone:732-389-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA003420152WC0802X
NY56-0003208152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU48493Medicare UPIN
NJ072434BEQMedicare ID - Type Unspecified