Licatino, Mark Anthony
Licatino, Mark Anthony is an individual health care provider with primary practice located at 85 Loop 150 W , Bastrop TX 78602-3930. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Licatino, Mark Anthony can be contacted via phone (512) 303-7300.Contact Information
Primary practice address
85 Loop 150 W
Bastrop TX 78602-3930
Phone: (512) 303-7300
Fax: (512) 303-2148
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2442TG | Texas |
Profile Details
| NPI number | 1083690051 |
|---|---|
| LBN Legal business name | Licatino, Mark Anthony |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 21st, 2005 |
| Last updated | Feb 1st, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083690051 | NPPES |
| Texas | Other | 911390 | BLOCK VISION |
| Texas | Other | VP11653 | BLOCK VISION |
| Texas | MEDICAID | 117899802 | BLOCK VISION |
| Texas | Other | 10013121 | BLOCK VISION |
| Texas | MEDICAID | 117899803 | BLOCK VISION |
| Texas | Other | 146573100 | BLOCK VISION |
| Texas | Other | 32787-013 | BLOCK VISION |
| Texas | Other | 8114413 | BLOCK VISION |
| Texas | Other | 4511497 | BLOCK VISION |
| Texas | Other | 88Y393 | BLOCK VISION |
| Texas | Other | TX2442 | BLOCK VISION |
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