Individual
MARK HERSHOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
53 PUBLIC SQ STE 102, WATERTOWN, NY 13601-2674
(315) 681-6379
Mailing address
53 PUBLIC SQ STE 102, WATERTOWN, NY 13601-2674
(315) 681-6379
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV007244
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52833A
MEDICARE PTAN
NY
01
—
TUV007244
NY STATE LICENSE
NY
Enumeration date
06/28/2005
Last updated
08/24/2021
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