Individual
MARK EDWARD STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1200 W GODFREY AVE, ADMINISTRATION SUITE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Mailing address
1200 W GODFREY AVE, ADMINISTRATION SUITE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG002389
PA
Other
Enumeration date
08/02/2010
Last updated
08/02/2010
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