Individual
MR. MARK HUMPHRIES JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
21611 VILLAGE LAKES SHOPPING CENTER, LAND O LAKES, FL 34639-5102
(813) 949-1982
(813) 949-0422
Mailing address
21611 VILLAGE LAKES SHOPPING CENTER, LAND O LAKES, FL 34639-5102
(813) 949-1982
(813) 949-0422
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
674
MS
152W00000X
Optometrist
776
LA
152W00000X
Optometrist
Primary
OPC001159
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084928600
—
FL
01
—
101718
AUMED
FL
01
—
19161A
BCBS FL
FL
01
—
38918
DAVIS
FL
Enumeration date
09/20/2006
Last updated
08/22/2008
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