Provider Demographics
NPI:1639256878
Name:TOPOLEWSKI, MARK ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:TOPOLEWSKI
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 1:4868 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1517
Mailing Address - Country:US
Mailing Address - Phone:810-982-3937
Mailing Address - Fax:810-982-0205
Practice Address - Street 1:4868 LAPEER RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1517
Practice Address - Country:US
Practice Address - Phone:810-982-3937
Practice Address - Fax:810-982-0205
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2737509Medicaid
MI2737509Medicaid
MI0G46299Medicare PIN