Provider Demographics
NPI:1912913047
Name:RAFFERTY, MARK C (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:29 S WEBSTER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:630-357-6880
Mailing Address - Fax:630-357-6995
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-357-6880
Practice Address - Fax:630-357-6995
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL046-009058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214906Medicare PIN