Provider Demographics
NPI:1093687188
Name:MUCKENFUSS, MARK D (LDO)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:MUCKENFUSS
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SW 19TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1393
Mailing Address - Country:US
Mailing Address - Phone:352-237-7155
Mailing Address - Fax:
Practice Address - Street 1:2600 SW 19TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1393
Practice Address - Country:US
Practice Address - Phone:352-237-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3302156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician