Individual
MARK ALLEN MOTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1355 WEST MAIN ST, BELLEVUE, OH 44811
(419) 483-7685
(419) 483-4694
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT.003300
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00130216
ANTHEM
—
01
—
00164996
ANTHEM
OH
05
—
0333704
—
OH
01
—
1750494530
OHIO BWC
OH
01
—
791580458
RAILROAD MEDICARE
OH
Enumeration date
08/16/2006
Last updated
12/03/2020
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