Provider Demographics
NPI:1871517227
Name:TEUNIS, MARK R SR (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:TEUNIS
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11142 ROBINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:301-791-2020
Mailing Address - Fax:301-733-6994
Practice Address - Street 1:11142 ROBINWOOD DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6702
Practice Address - Country:US
Practice Address - Phone:301-791-2020
Practice Address - Fax:301-733-6994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD322100800Medicaid
U17850Medicare UPIN
MD322100800Medicaid