Provider Demographics
NPI:1679553697
Name:TOMSIK, MARK D
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:TOMSIK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:D
Other - Last Name:TOMSIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3433 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-5101
Mailing Address - Country:US
Mailing Address - Phone:228-475-8641
Mailing Address - Fax:228-475-8691
Practice Address - Street 1:3433 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-5101
Practice Address - Country:US
Practice Address - Phone:228-475-8641
Practice Address - Fax:228-475-8691
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087042Medicaid
MS410019863OtherMEDICARE RAILROAD
MST21013Medicare UPIN
MS00087042Medicaid
MS560000020Medicare PIN