Provider Demographics
NPI:1871566794
Name:TRAVEIS, MARK A (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:TRAVEIS
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 1:385 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1944
Mailing Address - Country:US
Mailing Address - Phone:781-272-9365
Mailing Address - Fax:781-272-0366
Practice Address - Street 1:385 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-1944
Practice Address - Country:US
Practice Address - Phone:781-272-9365
Practice Address - Fax:781-272-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369748Medicaid
MA0369748Medicaid
MAW26004Medicare PIN