Provider Demographics
NPI:1255344388
Name:BOLSTEIN, MARK RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:BOLSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:686 MISTY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2335
Mailing Address - Country:US
Mailing Address - Phone:215-283-2565
Mailing Address - Fax:215-362-0528
Practice Address - Street 1:600 MONTGOMERY MALL
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-3912
Practice Address - Country:US
Practice Address - Phone:215-361-8282
Practice Address - Fax:215-362-0528
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOET008974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist