Provider Demographics
NPI:1609830249
Name:COTTER, MARK CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:COTTER
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 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:100 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7173
Practice Address - Country:US
Practice Address - Phone:336-342-3336
Practice Address - Fax:336-342-3226
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909228OtherMEDICAID GROUP #
NC890905FMedicaid
NCDD8241OtherRAILROAD MCARE GROUP #
NCP00253796OtherRAILROAD MCARE PROV #
NC7909232OtherMEDICAID GROUP N#
NC011W8OtherBCBS GROUP #
NC017NKOtherBCBS GROUP #
NC0905FOtherBCBS PROV #
NC09228OtherBCBS GROUP #
NC89011W8OtherMEDICAID GROUP #
NC246648IOtherMEDICARE GROUP #
NC246648WOtherMEDICARE GROUP #
NC8909406OtherMEDICAID GROUP #
NC0905FOtherBCBS PROV #
NC7909232OtherMEDICAID GROUP N#
NC246648IOtherMEDICARE GROUP #
NC0139010009Medicare NSC