Provider Demographics
NPI:1679525273
Name:WARD, MARK M (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:WARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5801 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3006
Mailing Address - Country:US
Mailing Address - Phone:509-965-6405
Mailing Address - Fax:509-965-5966
Practice Address - Street 1:5801 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3006
Practice Address - Country:US
Practice Address - Phone:509-965-6405
Practice Address - Fax:509-965-5966
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031045Medicaid
WA2031045Medicaid
WAG8854796Medicare ID - Type Unspecified