Provider Demographics
NPI:1457356966
Name:DOBIN, MARK N (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:N
Last Name:DOBIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8124 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2061
Mailing Address - Country:US
Mailing Address - Phone:954-757-8366
Mailing Address - Fax:954-757-2456
Practice Address - Street 1:8124 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2061
Practice Address - Country:US
Practice Address - Phone:954-757-8366
Practice Address - Fax:954-757-2456
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1202152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0078944500Medicaid
FLT84215Medicare UPIN
FL19823AMedicare ID - Type Unspecified