Provider Demographics
NPI:1184620114
Name:FORSTER, MARK JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:FORSTER
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 WALTHER RD
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8725
Mailing Address - Country:US
Mailing Address - Phone:770-513-3300
Mailing Address - Fax:770-513-3350
Practice Address - Street 1:725 WALTHER RD
Practice Address - Street 2:BUILDING 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8725
Practice Address - Country:US
Practice Address - Phone:770-513-3300
Practice Address - Fax:770-513-3350
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001383T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU48347Medicare UPIN
GA4070140001Medicare NSC
GA41ZCDTZMedicare PIN