Provider Demographics
NPI:1972614923
Name:LUND, MARK STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:LUND
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 1:410 LONG TRAIL TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7763
Mailing Address - Country:US
Mailing Address - Phone:301-762-2974
Mailing Address - Fax:301-762-2975
Practice Address - Street 1:6 GRAND CORNER AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-7303
Practice Address - Country:US
Practice Address - Phone:301-948-2020
Practice Address - Fax:301-948-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001380152W00000X
MDTA1880152W00000X
TXT3196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V02268Medicare UPIN
GO1983Medicare ID - Type Unspecified