1447279062 NPI number — DR. MARK H VINSON O.D.

Table of content: DR. MARK H VINSON O.D. (NPI 1447279062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447279062 NPI number — DR. MARK H VINSON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VINSON
Provider First Name:
MARK
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447279062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2614 E HIGHWAY 76
Provider Second Line Business Mailing Address:
P.O. BOX 1469
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29571-6336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-423-7229
Provider Business Mailing Address Fax Number:
843-423-1971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2614 E HIGHWAY 76
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29571-6336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-423-7229
Provider Business Practice Location Address Fax Number:
843-423-1971
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  789 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com