Individual
MARK ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4401 MORRIS LANE, TEXARKANA, TX 75503
(903) 838-9063
(903) 838-9074
Mailing address
PO BOX 5809, TEXARKANA, TX 75505-5809
(903) 838-9063
(903) 838-9074
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
05370TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041984803
—
TX
01
—
1285681304
GROUP NPI
TX
05
—
132451722
—
AR
Enumeration date
07/15/2005
Last updated
09/24/2012
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