Provider Demographics
NPI:1780685552
Name:SKOWRON, MARK L (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:SKOWRON
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 1:370 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2320
Mailing Address - Country:US
Mailing Address - Phone:630-834-6244
Mailing Address - Fax:630-834-2209
Practice Address - Street 1:370 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2320
Practice Address - Country:US
Practice Address - Phone:630-834-6244
Practice Address - Fax:630-834-2209
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410040179OtherMEDICARE RAILROAD
IL683120Medicare PIN
ILT37811Medicare UPIN
IL0146820002Medicare NSC
IL410040179OtherMEDICARE RAILROAD