Provider Demographics
NPI:1922168228
Name:CHAVANA, MARK EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:CHAVANA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9607 RESEARCH BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6582
Mailing Address - Country:US
Mailing Address - Phone:512-794-3937
Mailing Address - Fax:512-794-0259
Practice Address - Street 1:9607 RESEARCH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6582
Practice Address - Country:US
Practice Address - Phone:512-794-3937
Practice Address - Fax:512-794-0259
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX5104TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist