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NPI Code Detail

MEDICARE: MARK HERSHOWITZ O.D.

MEDICARE: MARK HERSHOWITZ 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
1152W00000XOptometristTUV007244NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152833AOTHERNYMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2TUV007244OTHERNYNY STATE LICENSE

General Provider Information

NPI Number : 1275530834
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK HERSHOWITZ O.D.
Provider Business Mailing Address
First Line : 53 PUBLIC SQ STE 102
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2674
Country : US
Telephone Number : 315-681-6379
Fax Number :
Provider Business Practice Location Address
First Line : 53 PUBLIC SQ STE 102
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2674
Country : US
Telephone Number : 315-681-6379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 08/24/2021

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