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General NPI Number Information
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NPI Number | 1174853824
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Entity Type | Organization
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Legal Business Name | MARK A PLUMB OD PA
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Dates
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Enumeration Date | 12/31/2009
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 10652 OLD HAMMOCK WAY
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City | WELLINGTON
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State | FL
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Zip | 33414-3148
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Country | US
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Telephone | 561-795-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 10652 OLD HAMMOCK WAY
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City | WELLINGTON
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State | FL
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Zip | 33414-3148
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Country | US
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Telephone | 561-795-8833
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ANTHONY PLUMB
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Credential | O.D
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Telephone | 561-596-9775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC003267
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License Number State | FL
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