MEDICARE: MENDELSON & MARK OPTOMETRIC CORPORATION

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	152WC0802X	Corneal and Contact Management Optometrist
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1942960661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDELSON & MARK OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	1010 W. FREMONT AVE.
Second Line	:	SUITE 200
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3019
Country	:	US
Telephone Number	:	408-739-6200
Fax Number	:	408-739-2439

Provider Business Practice Location Address
First Line	:	1010 W. FREMONT AVE
Second Line	:	SUITE 200
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3019
Country	:	US
Telephone Number	:	408-739-6200
Fax Number	:	408-739-2439

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. LISA ANN BEEM
Credential	:
Telephone Number	:	408-739-6200

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	10/20/2022

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Directions to “MENDELSON & MARK OPTOMETRIC CORPORATION ” Practice Location

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