Organization
MARK A ELLISON, LTD
Active
Other names
Family Vision Care of Southern Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A. ELLISON O.D. (PRESIDENT)
(618) 635-2424
Entity
Organization
Contact information
Practice address
422 W BETHALTO DR, BETHALTO, IL 62010-1700
(618) 377-5221
(618) 377-5220
Mailing address
422 W BETHALTO DR, BETHALTO, IL 62010-1700
(618) 377-5221
(618) 377-5220
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007313
IL
Other
Enumeration date
05/11/2006
Last updated
08/21/2008
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