Provider Demographics
NPI:1174691513
Name:HASSINGER, MARK ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:HASSINGER
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:PO BOX 207170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7170
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:5370 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-1552
Practice Address - Country:US
Practice Address - Phone:440-842-6996
Practice Address - Fax:440-842-9380
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1872 035152W00000X
OH3611 T476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0524196Medicaid