MEDICARE: DR. MARK S FORREST 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	OEG000938	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001682167	OTHER	PA	HIGHMARK BLUE SHIELD ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2356861000	OTHER	PA	HMO ID

General Provider Information

NPI Number	:	1871531038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK S FORREST O.D.

Provider Business Mailing Address
First Line	:	2570 BARNSLEIGH DR
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-7827
Country	:	US
Telephone Number	:	215-752-5929
Fax Number	:	215-945-1425

Provider Business Practice Location Address
First Line	:	1409 LINCOLN HWY
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19056-1137
Country	:	US
Telephone Number	:	215-943-4637
Fax Number	:	215-945-1425

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/20/2015

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