Provider Demographics
NPI:1861491144
Name:SARNO, MARK J (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:SARNO
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 1:8250 BRYAN DAIRY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1357
Mailing Address - Country:US
Mailing Address - Phone:727-489-0500
Mailing Address - Fax:727-489-0508
Practice Address - Street 1:10785 102ND AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33778-4211
Practice Address - Country:US
Practice Address - Phone:727-209-3937
Practice Address - Fax:727-394-7393
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084987100Medicaid
FL084987101Medicaid
FLT84110Medicare UPIN
FL084987101Medicaid
FL19744XMedicare PIN
FL19744Medicare ID - Type Unspecified
FL19744YMedicare PIN
FL19744VMedicare PIN