Individual
DR. MARK ALLEN ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
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
046-007313
IL
Other
Enumeration date
07/06/2007
Last updated
08/21/2008
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