Provider Demographics
NPI:1326261702
Name:MCLOUGHLIN, MARK THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:MCLOUGHLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 N CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-4237
Mailing Address - Country:US
Mailing Address - Phone:773-625-3602
Mailing Address - Fax:773-625-3869
Practice Address - Street 1:4642 N CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-4237
Practice Address - Country:US
Practice Address - Phone:773-625-3602
Practice Address - Fax:773-625-3869
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist