Mark a Ellison, LTD
Organization Active NPI Optometrist · Bethalto, IL
NPI 1013967116 · NPPES record last updated Aug 21, 2008
Key facts
- NPI
- 1013967116
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 046007313 (IL)
- Legal business name
- MARK A ELLISON, LTD
- Practice address
- 422 W Bethalto Dr
Bethalto, IL 62010-1700 - Phone
- (618) 377-5221
- Fax
- (618) 377-5220
- NPI assigned
- May 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark A. Ellison, O.D.
- Title
- President
- Phone
- (618) 635-2424
Practitioners 2
-
Keith R. Hamm, O.D.
National Provider Directory
Locations
422 W Bethalto Dr
Bethalto, IL 62010
Phone (618) 377-5221
207 W Main St
Staunton, IL 62088
Phone (618) 635-2424
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 046007313 | IL | Yes |
Addresses
Primary practice location
422 W Bethalto Dr
Bethalto, IL 62010-1700
Mailing address
422 W Bethalto Dr
Bethalto, IL 62010-1700
Phone (618) 377-5221
Other names
- Family Vision Care of Southern Illinois
Other providers in Bethalto, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.