Individual
DR. MARK ANTHONY LICATINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
85 LOOP 150 W, BASTROP, TX 78602-3930
(512) 303-7300
(512) 303-2148
Mailing address
5717 BALCONES DR, AUSTIN, TX 78731-4203
(512) 327-7000
(512) 314-1660
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2442TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10013121
AMERIGROUP
TX
05
—
117899802
—
TX
05
—
117899803
—
TX
01
—
146573100
FIRST CARE
—
01
—
32787-013
DAVIS VISION
NY
01
—
4511497
AETNA
TX
01
—
8114413
BLUELINK
TX
01
—
88Y393
BLUE CROSS BLUE SHIELD
TX
01
—
911390
BLOCK VISION
TX
01
—
TX2442
EYEMED
OH
01
—
VP11653
GE WELLNESS
—
Enumeration date
12/21/2005
Last updated
02/01/2010
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