# MR. MARK HUMPHRIES JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1467550731
- **Gender:** Man
- **Credential:** OD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 674 | MS | — |
| 152W00000X | Optometrist | 776 | LA | — |
| 152W00000X | Optometrist | OPC001159 | FL | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 084928600 | — | FL |
| 01 | — | 101718 | AUMED | FL |
| 01 | — | 19161A | BCBS FL | FL |
| 01 | — | 38918 | DAVIS | FL |