Provider Demographics
NPI:1811049810
Name:MAHER, MARK PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PAUL
Last Name:MAHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:419 VINEYARD TOWN CENTER
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-779-2266
Mailing Address - Fax:408-779-5051
Practice Address - Street 1:419 VINEYARD TOWN CENTER
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037
Practice Address - Country:US
Practice Address - Phone:408-779-2266
Practice Address - Fax:408-779-5051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT609AOtherPTAN
T01632Medicare UPIN