Provider Demographics
NPI:1861706202
Name:STURM, MARK DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DANIEL
Last Name:STURM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1013 W UNIVERSITY AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-5340
Mailing Address - Country:US
Mailing Address - Phone:512-869-8821
Mailing Address - Fax:512-869-8849
Practice Address - Street 1:1013 W UNIVERSITY AVE
Practice Address - Street 2:STE 135
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5340
Practice Address - Country:US
Practice Address - Phone:512-869-8821
Practice Address - Fax:512-869-8849
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7643TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist