Organization
DR. MARK NOSS LLC
Active
Other names
Dr. Mark Noss
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DAVID NOSS O.D. (OPTOMETRIST)
(231) 946-8460
Entity
Organization
Contact information
Practice address
328 MUNSON AVE, TRAVERSE CITY, MI 49686-3040
(231) 946-8460
(231) 946-8507
Mailing address
328 MUNSON AVE, TRAVERSE CITY, MI 49686-3040
(231) 946-8460
(231) 946-8507
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002760
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0622010001
DMEPOS
MI
01
—
1205814779
INDIVIDUAL NPI
MI
05
—
5088450
—
MI
01
—
900B814120
BCBSM- FOR GROUP NPI
MI
01
—
900B865060
BCBS
MI
Enumeration date
11/02/2006
Last updated
12/22/2009
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