Individual
DR. MARK DAVID SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4949 W.IRVING PK. RD., SUITE E, CHICAGO, IL 60641-2655
(773) 237-4774
(773) 202-9902
Mailing address
4949 W.IRVING PK. RD., SUITE E, CHICAGO, IL 60641-2655
(773) 237-4774
(773) 202-9902
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-0008177
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001607656
BCBS
IL
Enumeration date
10/03/2006
Last updated
07/08/2007
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