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General NPI Number Information
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NPI Number | 1962580159
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Entity Type | Organization
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Legal Business Name | DR. MARK NOSS LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 328 MUNSON AVE
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3040
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Country | US
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Telephone | 231-946-8460
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Fax | 231-946-8507
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Provider Business Mailing Address
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Address Line | 328 MUNSON AVE
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3040
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Country | US
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Telephone | 231-946-8460
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Fax | 231-946-8507
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MARK DAVID NOSS
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Credential | O.D.
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Telephone | 231-946-8460
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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 | 4901002760
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License Number State | MI
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