Provider Demographics
NPI:1801892773
Name:ALPERT, MARK WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:ALPERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16102 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4606
Mailing Address - Country:US
Mailing Address - Phone:562-867-4716
Mailing Address - Fax:562-925-6877
Practice Address - Street 1:16102 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4606
Practice Address - Country:US
Practice Address - Phone:562-867-4716
Practice Address - Fax:562-925-6877
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04969TPA152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0049690Medicaid
CASD0049690Medicaid