Mark Anthony Licatino, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2442TG Issued in TX

Practice address

85 Loop 150 W
Bastrop, TX 78602-3930

Phone

(512) 303-7300

Fax

(512) 303-2148

NPI assigned

Dec 21, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eye Clinic of Austin PLLC

  dba Eye Clinic of Austin

  • Ophthalmology Physician
  • Austin, TX
  • NPI 1023363926

  Optometrist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264982400000",
    "number": "1083690051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5717 BALCONES DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787314203",
            "telephone_number": "512-327-7000",
            "fax_number": "512-314-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 LOOP 150 W",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786023930",
            "telephone_number": "512-303-7300",
            "fax_number": "512-303-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICATINO",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2010-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2442TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "911390",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GE WELLNESS",
            "identifier": "VP11653",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117899802",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10013121",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117899803",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CARE",
            "identifier": "146573100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "32787-013",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUELINK",
            "identifier": "8114413",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4511497",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "88Y393",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "TX2442",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Lassen, DMD
• Laurier a. Vocal (Family Health Center of Bastrop)
• Kyoung Lee
• Sammy Lerma III, M.D.
• Let's Talk, Bastrop, PLLC
• Lincoln Clinic
• Lisa Willmon LPC-S PLLC
• Arthur Henry Litteken II, MA
• Chung-Chieh Lo, M.D.
• Lock,S Drug Store at Bastrop,Inc (lock drug)

• Optometrist in Bastrop, TX
• Providers in Bastrop, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.