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NPI Code Detail

MEDICARE: DR. MARK W GIFFORD O.D.

MEDICARE: DR. MARK W GIFFORD 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
1152W00000XOptometrist2112NC
2152W00000XOptometrist2006017274MO
3152W00000XOptometrist1515SC

General Provider Information

NPI Number : 1598798100
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK W GIFFORD O.D.
Provider Business Mailing Address
First Line : 3219 PINEVILLE MATTHEWS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-9301
Country : US
Telephone Number : 704-541-0468
Fax Number : 704-542-0318
Provider Business Practice Location Address
First Line : 3219 PINEVILLE MATTHEWS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-9301
Country : US
Telephone Number : 704-541-0468
Fax Number : 704-542-0318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 02/15/2009

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