Provider Demographics
NPI:1487752218
Name:HABIG, MARK W (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:HABIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BADE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9329
Mailing Address - Country:US
Mailing Address - Phone:317-897-8264
Mailing Address - Fax:925-889-2485
Practice Address - Street 1:4900 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3507
Practice Address - Country:US
Practice Address - Phone:317-782-4000
Practice Address - Fax:317-782-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001795A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU26417Medicare UPIN
IN211030Medicare ID - Type UnspecifiedMEDICARE ID