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General NPI Number Information
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NPI Number | 1841389152
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Entity Type | Individual
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Provider Name | MARK D BALTER OD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 2201 NW MARKET ST
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City | SEATTLE
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State | WA
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Zip | 98107-4025
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Country | US
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Telephone | 206-789-7417
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Fax | 206-789-7651
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Provider Business Mailing Address
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Address Line | 2201 NW MARKET ST
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City | SEATTLE
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State | WA
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Zip | 98107-4025
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Country | US
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Telephone | 206-789-7417
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Fax | 206-789-7651
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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 | 1411TX
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1411TX
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License Number State | WA
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