Individual
MARK PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 BLUEBELL AVE, BOULDER, CO 80302-7834
(541) 915-0291
Mailing address
1400 BLUEBELL AVE, BOULDER, CO 80302-7834
(541) 915-0291
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
75599
CA
207W00000X
Ophthalmology Physician
Primary
DR.0054602
CO
207W00000X
Ophthalmology Physician
MD22302
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130311
—
OR
01
—
180040741
RAILROAD MEDICARE
—
01
—
180043385
RAILROAD MEDICARE
—
Enumeration date
07/12/2005
Last updated
12/20/2018
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