Provider Demographics
NPI:1356338636
Name:FECHTEL, MARK EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:FECHTEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-961-4605
Practice Address - Street 1:16968 W BELL RD STE 402
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8943
Practice Address - Country:US
Practice Address - Phone:623-214-0353
Practice Address - Fax:623-214-0693
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ164118Medicare PIN
AZZ162074Medicare PIN
AZU84799Medicare UPIN
AZZ162079Medicare PIN
AZZ162077Medicare PIN
AZZ164122Medicare PIN
AZZ164120Medicare PIN
AZZ164121Medicare PIN
AZZ65440Medicare PIN
AZZ164119Medicare PIN
AZZ164123Medicare PIN
AZZ162075Medicare PIN
AZZ162076Medicare PIN
AZZ162078Medicare PIN