Provider Demographics
NPI:1376701037
Name:MARK E. ALLMARAS O D P C
Entity Type:Organization
Organization Name:MARK E. ALLMARAS O D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLMARAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-736-0093
Mailing Address - Street 1:2212 SOUTHLAKE MALL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6441
Mailing Address - Country:US
Mailing Address - Phone:219-736-0093
Mailing Address - Fax:
Practice Address - Street 1:2212 SOUTHLAKE MALL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6441
Practice Address - Country:US
Practice Address - Phone:219-736-0093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2014-04-03
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2010-12-01
Provider Licenses
StateLicense IDTaxonomies
IN18003325A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty