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General NPI Number Information
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NPI Number | 1609830249
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Entity Type | Individual
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Provider Name | MARK CHRISTOPHER COTTER O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 100 PROFESSIONAL DR
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City | REIDSVILLE
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State | NC
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Zip | 27320-7173
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Country | US
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Telephone | 336-342-3336
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Fax | 336-342-3226
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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Fax | 703-991-0514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1411
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License Number State | NC
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