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Individual

DR. MARK EDWARD FERGUSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
3300 GODFREY RD, GODFREY, IL 62035-2558
(618) 466-8787
(618) 466-4703
Mailing address
40 KINGSLEY WAY, GLEN CARBON, IL 62034-1548
(618) 288-7350

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008331
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046008331
IL
Enumeration date
03/09/2007
Last updated
09/02/2010
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