Provider Demographics
NPI:1134266844
Name:DONLON, MARK JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:DONLON
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 1:337 APPLEGARTH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3721
Mailing Address - Country:US
Mailing Address - Phone:609-655-2666
Mailing Address - Fax:609-655-2692
Practice Address - Street 1:337 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3721
Practice Address - Country:US
Practice Address - Phone:609-655-2666
Practice Address - Fax:609-655-2692
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ5189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200487881OtherPROVIDER ID
NJY12416Medicare UPIN
NJ200487881OtherPROVIDER ID