Provider Demographics
NPI:1447346689
Name:MARK R. RAHNER, O.D., P.C.
Entity type:Organization
Organization Name:MARK R. RAHNER, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:RAHNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-247-8762
Mailing Address - Street 1:1165 S CAMINO DEL RIO STE 100
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6824
Mailing Address - Country:US
Mailing Address - Phone:970-247-8762
Mailing Address - Fax:970-385-4496
Practice Address - Street 1:1165 S CAMINO DEL RIO STE 100
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6824
Practice Address - Country:US
Practice Address - Phone:970-247-8762
Practice Address - Fax:970-385-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO932152W00000X
CO1168152W00000X
CO2404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60766Medicare UPIN
COCF6203Medicare PIN
COU77212Medicare UPIN
COT10605Medicare UPIN