Provider Demographics
NPI:1225378979
Name:ELTIS, MARK (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ELTIS
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 SPADINA AVENUE
Mailing Address - Street 2:SUITE 2308
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M5S 2H8
Mailing Address - Country:CA
Mailing Address - Phone:416-873-5657
Mailing Address - Fax:
Practice Address - Street 1:44 BLOOR ST EAST
Practice Address - Street 2:HUDSON BAY CENTRE CONCOURSE LEVEL
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M4W 3H7
Practice Address - Country:CA
Practice Address - Phone:416-963-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist