Provider Demographics
NPI:1588669121
Name:STINES, MARK H (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:STINES
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 1:401 N EDDY ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-4558
Mailing Address - Country:US
Mailing Address - Phone:308-384-6922
Mailing Address - Fax:308-384-7824
Practice Address - Street 1:401 N EDDY ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-4558
Practice Address - Country:US
Practice Address - Phone:308-384-6922
Practice Address - Fax:308-384-7824
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE865Medicaid
NET40299Medicare UPIN
NE087063Medicare PIN
NE096584Medicare PIN