Mark Anthony Licatino O.D.

NPI 1083690051 - Optometrist - 152W00000X

NPI Details
NPI 1083690051
Gender Male
Enumeration Date 12/21/2005
Last Updated 02/01/2010
Entity Type Individual
Active Over 11 years ago
Practice Location
85 LOOP 150 W
BASTROP TX, 78602-3930, US
Phone (512) 303-7300
Fax (512) 303-2148
Business Location
AUSTIN TX, 78731-4203, US
Phone (512) 327-7000
Fax (512) 314-1660
Taxonomy Code 152W00000X
License State Texas
License Number 2442TG
Remove 1083690051 NPI Number

According to our database, Dr. Mark Anthony Licatino O.D. NPI is 1083690051, taxonomy code is 152W00000X and license number is 2442TG, license state is located at Texas. Mark Anthony Licatino O.D. physically located at 85 Loop 150 W, Bastrop TX, 78602-3930. NPI Number Mark Anthony Licatino O.D. has the Individual type.

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1083690051 NPI number is provided on an as is basis without warranty of any kind. 1083690051 is maintained by the National Plan & Provider Enumeration System. The contents of Mark Anthony Licatino O.D. are for informational purposes only.