Individual
MARK D POPHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
29001 CEDAR RD STE 110, LYNDHURST, OH 44124-4041
(216) 382-8022
(216) 382-7667
Mailing address
PO BOX 378, SANDUSKY, OH 44871-0378
(419) 626-6161
(419) 502-3511
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35-05-9490-P
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1193810001
DMERC MEDICARE
OH
01
—
180028844
RAILROAD MEDICARE
—
05
—
2027612
—
OH
01
—
34-1844400
TAX ID#
OH
01
—
H140671
MEDICARE
OH
Enumeration date
08/24/2005
Last updated
06/22/2020
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