Provider Demographics
NPI:1366535528
Name:ALLES, MARK M (OD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:M
Last Name:ALLES
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Gender:M
Credentials:OD
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Mailing Address - Street 1:963 N. 129TH INFANTRY DR.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3103
Mailing Address - Country:US
Mailing Address - Phone:815-725-9377
Mailing Address - Fax:815-725-9358
Practice Address - Street 1:963 N. 129TH INFANTRY DR.
Practice Address - Street 2:SUITE 110
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-725-9377
Practice Address - Fax:815-725-9358
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-08-16
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Provider Licenses
StateLicense IDTaxonomies
IL046-008527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV02580Medicare UPIN