=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396126108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK B. BYERS, O.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2015
-----------------------------------------------------
Last Update Date | 06/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 429 D ST
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-5706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-742-1679
-----------------------------------------------------
Fax | 530-742-1233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 429 D ST
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-5706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-742-1679
-----------------------------------------------------
Fax | 530-742-1233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARK B BYERS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 530-742-1679
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------