Provider Demographics
NPI:1447279062
Name:VINSON, MARK H (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:VINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 E HIGHWAY 76
Mailing Address - Street 2:P.O. BOX 1469
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-6336
Mailing Address - Country:US
Mailing Address - Phone:843-423-7229
Mailing Address - Fax:843-423-1971
Practice Address - Street 1:2614 E HIGHWAY 76
Practice Address - Street 2:SUITE A
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6336
Practice Address - Country:US
Practice Address - Phone:843-423-7229
Practice Address - Fax:843-423-1971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3019Medicare ID - Type UnspecifiedGROUP#
SC5054Medicare ID - Type UnspecifiedGROUP#
SCT24944Medicare UPIN