Provider Demographics
NPI:1912965823
Name:WILMOTH, MARK D (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:WILMOTH
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Gender:M
Credentials:OD
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Mailing Address - Street 1:7451 WOODWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:630-663-9112
Mailing Address - Fax:630-663-9228
Practice Address - Street 1:7451 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517
Practice Address - Country:US
Practice Address - Phone:630-663-9112
Practice Address - Fax:630-663-9228
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2022-03-20
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Provider Licenses
StateLicense IDTaxonomies
IL046-009127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist