Provider Demographics
NPI:1558386953
Name:WILLINGER, MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WILLINGER
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 1:5135 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3944
Mailing Address - Country:US
Mailing Address - Phone:937-277-9991
Mailing Address - Fax:937-277-9719
Practice Address - Street 1:5135 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3944
Practice Address - Country:US
Practice Address - Phone:937-277-9991
Practice Address - Fax:937-277-9719
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH176855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0711895Medicaid
OHH009060Medicare PIN
OH0683780001Medicare NSC
OH0711895Medicaid