Provider Demographics
NPI:1871531038
Name:FORREST, MARK S (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:FORREST
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 1:2570 BARNSLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7827
Mailing Address - Country:US
Mailing Address - Phone:215-752-5929
Mailing Address - Fax:215-945-1425
Practice Address - Street 1:1409 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1137
Practice Address - Country:US
Practice Address - Phone:215-943-4637
Practice Address - Fax:215-945-1425
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001682167OtherHIGHMARK BLUE SHIELD ID
PA7758158Medicaid
PA2356861000OtherHMO ID
T27171Medicare UPIN