Provider Demographics
NPI:1588723274
Name:NACHMAN, MARK HOWARD (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HOWARD
Last Name:NACHMAN
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:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-0319
Mailing Address - Country:US
Mailing Address - Phone:570-992-5454
Mailing Address - Fax:570-992-4466
Practice Address - Street 1:RT 209 BOX 319
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-0319
Practice Address - Country:US
Practice Address - Phone:570-992-5454
Practice Address - Fax:570-992-4466
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE4620P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA51962OtherDAVIS VISION
PA073907OtherFP HEALTH
PA073907OtherFP HEALTH
PA51962OtherDAVIS VISION