Provider Demographics
NPI:1548540438
Name:LIBASSI, MARK (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LIBASSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1450 ATWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4840
Mailing Address - Country:US
Mailing Address - Phone:401-943-4330
Mailing Address - Fax:401-943-4331
Practice Address - Street 1:1395 ATWOOD AVE STE 103
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4930
Practice Address - Country:US
Practice Address - Phone:401-943-4330
Practice Address - Fax:401-943-4331
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2019-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI113156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician