Provider Demographics
NPI:1003940602
Name:MARK L. SKOWRON PC
Entity Type:Organization
Organization Name:MARK L. SKOWRON PC
Other - Org Name:SKOWRON EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:SKOWRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-834-6244
Mailing Address - Street 1:370 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2320
Mailing Address - Country:US
Mailing Address - Phone:630-834-6244
Mailing Address - Fax:
Practice Address - Street 1:370 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2320
Practice Address - Country:US
Practice Address - Phone:630-834-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1780685552OtherINDIVIDUAL NPI NUMBER
ILDN4795OtherMEDICARE RAILROAD
ILMS0212162OtherDEA NUMBER
IL0146820002Medicare NSC
IL683120Medicare ID - Type Unspecified
IL683120Medicare PIN
IL1780685552OtherINDIVIDUAL NPI NUMBER
ILDN4795OtherMEDICARE RAILROAD