Individual
MARK ALAN COUTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
202 N MAIN ST, CULVER, IN 46511-1516
(574) 842-3372
(574) 842-3372
Mailing address
202 N MAIN ST, CULVER, IN 46511-1516
(574) 842-3372
(574) 842-3372
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002062A, B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100279120A
—
IN
Enumeration date
06/30/2005
Last updated
04/28/2008
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