Basic Information
| Provider Information | |||||||||
| NPI: | 1013910595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOKES | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 367 W. EVANS STREET | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295013429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436694156 | ||||||||
| FaxNumber: | 8436642121 | ||||||||
| Practice Location | |||||||||
| Address1: | 367 W EVANS ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295013429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436694156 | ||||||||
| FaxNumber: | 8436642122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 17156 | SC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 276366 | 01 | SC | PRIVATE HEALTHCARE SYSTEM | OTHER | 171566 | 05 | SC | MEDICAID | 180022655 | 01 | SC | RAILROAD MEDICARE | OTHER | S327576 | 01 | SC | CIGNA | OTHER | 4511548 | 01 | SC | AETNA | OTHER | 622035 | 01 | SC | SELECT HEALTH | OTHER | 9624212 | 01 | SC | GHI | OTHER | 890602G | 05 | NC | MEDICAID |