Provider Demographics
NPI:1376689521
Name:MCALLISTER, MARTHA ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ANNE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:541 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6304
Mailing Address - Country:US
Mailing Address - Phone:630-545-2628
Mailing Address - Fax:
Practice Address - Street 1:152 S BLOOMINGDALE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1481
Practice Address - Country:US
Practice Address - Phone:630-879-4446
Practice Address - Fax:630-980-2313
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
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