Wilson, Mark Dennis

Wilson, Mark Dennis is an individual health care provider with primary practice located at 314 W Savidge St , Spring Lake MI 49456-1607. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wilson, Mark Dennis can be contacted via phone (616) 844-7000.

Contact Information

Primary practice address
314 W Savidge St Spring Lake MI 49456-1607
Phone: (616) 844-7000
Fax: (616) 844-7444
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 4901003705 Michigan

Profile Details

NPI number 1932195450
LBN Legal business name Wilson, Mark Dennis
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2005
Last updated Dec 10th, 2015 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932195450 NPPES
Michigan Other 204829649 TAX ID
Michigan Other 900F111210 TAX ID
Michigan MEDICAID (94)4830440 TAX ID
Michigan Other 383628290 TAX ID
Michigan Other 900F210170 TAX ID
Michigan Other 900E310260 TAX ID
Michigan Other 383521610 TAX ID
Michigan Other 201249427 TAX ID

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