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General NPI Number Information
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NPI Number | 1881746261
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Entity Type | Individual
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Provider Name | MARK J HAGEE O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 2091 W US HIGHWAY 22 AND 3
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City | MAINEVILLE
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State | OH
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Zip | 45039-9401
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Country | US
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Telephone | 513-677-8866
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Fax | 513-677-9113
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Provider Business Mailing Address
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Address Line | 2091 W US HIGHWAY 22 AND 3
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City | MAINEVILLE
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State | OH
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Zip | 45039-9401
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Country | US
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Telephone | 513-677-8866
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Fax | 513-677-9113
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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 | 3535
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License Number State | OH
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