Provider Demographics
NPI:1548310725
Name:PICKERING, MARK D (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:PICKERING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:D
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2518 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3209
Mailing Address - Country:US
Mailing Address - Phone:713-995-0042
Mailing Address - Fax:713-995-0548
Practice Address - Street 1:2518 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3209
Practice Address - Country:US
Practice Address - Phone:713-995-0042
Practice Address - Fax:713-995-0548
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03084TG174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist