Provider Demographics
NPI:1154605210
Name:MARK A HOROWITZ
Entity type:Organization
Organization Name:MARK A HOROWITZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-276-5099
Mailing Address - Street 1:1715 S FEDERAL HWY
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3329
Mailing Address - Country:US
Mailing Address - Phone:561-276-5099
Mailing Address - Fax:561-274-9697
Practice Address - Street 1:1715 S FEDERAL HWY
Practice Address - Street 2:SUITE C-1
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3329
Practice Address - Country:US
Practice Address - Phone:561-276-5099
Practice Address - Fax:561-274-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084868900Medicaid
FLT84054Medicare UPIN
FL19644AMedicare PIN