Provider Demographics
NPI:1609880889
Name:BIRKMANN, MARK G (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:BIRKMANN
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 1:1013 W UNIVERSITY AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-5359
Mailing Address - Country:US
Mailing Address - Phone:512-869-8821
Mailing Address - Fax:512-869-8849
Practice Address - Street 1:1013 W UNIVERSITY AVE STE 135
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5359
Practice Address - Country:US
Practice Address - Phone:512-869-8821
Practice Address - Fax:512-869-8849
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9137TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000009376Medicare ID - Type Unspecified