MEDICARE: DR. MARK ALLEN HORNE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2497	AR

General Provider Information

NPI Number	:	1134244783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALLEN HORNE O.D.

Provider Business Mailing Address
First Line	:	473425 E 1127 RD
Second Line	:
City	:	MULDROW
State	:	OK
Zip	:	74948-5643
Country	:	US
Telephone Number	:	918-427-7525
Fax Number	:	479-452-0978

Provider Business Practice Location Address
First Line	:	5111 ROGERS AVE STE 54
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2033
Country	:	US
Telephone Number	:	479-452-0928
Fax Number	:	479-452-0978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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