Provider Demographics
NPI:1851361125
Name:HEPNER, MARK L (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:HEPNER
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 1:309 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2000
Mailing Address - Country:US
Mailing Address - Phone:570-286-2541
Mailing Address - Fax:570-286-4180
Practice Address - Street 1:309 N 5TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2000
Practice Address - Country:US
Practice Address - Phone:570-286-2541
Practice Address - Fax:570-286-4180
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007711P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
197343YC8ZMedicare PIN
PA01521138Medicaid
PAU54357Medicare UPIN