Provider Demographics
NPI:1104812536
Name:MEADOWS, MARK K (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3449 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3100
Mailing Address - Country:US
Mailing Address - Phone:804-642-2290
Mailing Address - Fax:804-684-2166
Practice Address - Street 1:3449 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3100
Practice Address - Country:US
Practice Address - Phone:804-642-2290
Practice Address - Fax:804-684-2166
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA#0601800484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010026911Medicaid
VA010026911Medicaid
VAU97012Medicare UPIN