Provider Demographics
NPI:1578561270
Name:PAGE, MARK JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:PAGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15215 S 48TH ST
Mailing Address - Street 2:SUITE # 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9142
Mailing Address - Country:US
Mailing Address - Phone:480-706-3937
Mailing Address - Fax:480-706-4533
Practice Address - Street 1:15215 S 48TH ST
Practice Address - Street 2:SUITE # 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9142
Practice Address - Country:US
Practice Address - Phone:480-706-3937
Practice Address - Fax:480-706-4533
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOD 802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z62809Medicare PIN
AZU13635Medicare UPIN