Provider Demographics
NPI:1043861784
Name:BUYO, MARK ANTHONY (CNIM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:BUYO
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 WATERVIEW PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1566
Mailing Address - Country:US
Mailing Address - Phone:214-551-0257
Mailing Address - Fax:
Practice Address - Street 1:3400 WATERVIEW PKWY STE 305
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1566
Practice Address - Country:US
Practice Address - Phone:214-551-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4445156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist