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Contact Information

MARK A LICATINO, OD
85 LOOP 150 W
BASTROP, TX78602-3930
 Phone: 512-303-7300
 Fax: 512-303-2148
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for MARK A LICATINO · (Male)

NPI # 1083690051
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 12/21/2005
Last updated 02/01/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • TX License # 2442TG
  • TX Medicaid 117899802
  • TX Medicaid 117899803
  • Other 146573100 FIRST CARE
  • Other VP11653 GE WELLNESS
  • NY Other 32787-013 DAVIS VISION
  • OH Other TX2442 EYEMED
  • TX Other 4511497 AETNA
  • TX Other 10013121 AMERIGROUP
  • TX Other 911390 BLOCK VISION
  • TX Other 88Y393 BLUE CROSS BLUE SHIELD
  • TX Other 8114413 BLUELINK
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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