Provider Demographics
NPI:1104975945
Name:STRAHAN, MARK J (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:STRAHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10420 MAYSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9762
Mailing Address - Country:US
Mailing Address - Phone:260-492-5893
Mailing Address - Fax:260-493-5504
Practice Address - Street 1:10420 MAYSVILLE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-9762
Practice Address - Country:US
Practice Address - Phone:260-492-5893
Practice Address - Fax:260-493-5504
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001821B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34977Medicare UPIN
IN218500BMedicare PIN