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Individual
MR. MARK HUMPHRIES JR.
Active
Individual
MR. MARK HUMPHRIES JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
674
MS
152W00000X
Optometrist
776
LA
152W00000X
Optometrist
Primary
OPC001159
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084928600
—
FL
01
—
101718
AUMED
FL
01
—
19161A
BCBS FL
FL
01
—
38918
DAVIS
FL
Enumeration date
09/20/2006
Last updated
08/22/2008
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