Provider Demographics
NPI:1952401234
Name:FARBMAN, MARK LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:FARBMAN
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 1:265 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4938
Mailing Address - Country:US
Mailing Address - Phone:301-668-7993
Mailing Address - Fax:301-293-6133
Practice Address - Street 1:1560 OPOSSUMTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4748
Practice Address - Country:US
Practice Address - Phone:301-662-8866
Practice Address - Fax:301-293-6133
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4290491OtherAETNA
60645801OtherCAREFIRST BCBS
484151OtherAETNA-HMO
60645801OtherBLUE CROSS BLUE SHIELD
0001OtherBCBS FEP
34510OtherONENET
34510OtherMDIPA
34510OtherOPTIMUM CHOICE
34510OtherALLIANCE
34510OtherMAMSI/UNITED HEALTHCARE
620427OtherUNICARE
620427OtherHEALTHLINK/NCPPO
0001OtherBCBS FEP
34510OtherALLIANCE