Provider Demographics
NPI:1346474616
Name:MARK ALPERT O.D.
Entity Type:Organization
Organization Name:MARK ALPERT O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-867-4716
Mailing Address - Street 1:16102 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4606
Mailing Address - Country:US
Mailing Address - Phone:562-867-4716
Mailing Address - Fax:562-925-6877
Practice Address - Street 1:16102 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4606
Practice Address - Country:US
Practice Address - Phone:562-867-4716
Practice Address - Fax:562-925-6877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04969TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0161030001Medicare NSC