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General NPI Number Information
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NPI Number | 1154610251
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Entity Type | Organization
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Legal Business Name | MARK L HEPNER OPTOMETRIST LLC
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 309 N 5TH ST
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City | SUNBURY
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State | PA
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Zip | 17801-2000
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Country | US
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Telephone | 570-286-2541
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Fax | 570-286-4180
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Provider Business Mailing Address
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Address Line | 309 N 5TH ST
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City | SUNBURY
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State | PA
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Zip | 17801-2000
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Country | US
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Telephone | 570-286-2541
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Fax | 570-286-4180
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK L HEPNER
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Credential | OD
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Telephone | 570-286-2541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OE007711-P
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License Number State | PA
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