Organization
MARK A MOTLEY OD INC
Active
Organization
MARK A MOTLEY OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL SHAVER (BUSINESS OFFICE)
(419) 483-3720
Entity
Organization
Contact information
Practice address
423 W MAIN ST, BELLEVUE, OH 44811-1335
(419) 483-3720
Mailing address
PO BOX 277, BELLEVUE, OH 44811-0277
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3300-T018
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00130216
ANTHEM BLUE CROSS AND BLUE SHIELD
OH
01
—
00164996
ANTHEM BLUE CROSS AND BLUE SHIELD
OH
05
—
0333704
—
OH
01
—
1750494530
BWC BUREAU OF WORKER'S COMPENSATION
OH
01
—
2774494380001
MEDICAL MUTUAL
OH
01
—
791580458
RR MEDICARE
OH
Enumeration date
05/05/2008
Last updated
05/05/2008
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