Provider Demographics
NPI:1063206852
Name:IHRIG, MARK (ABO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:IHRIG
Suffix:
Gender:
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-3043
Mailing Address - Country:US
Mailing Address - Phone:707-639-4984
Mailing Address - Fax:707-426-4875
Practice Address - Street 1:350 WALTERS RD
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-3043
Practice Address - Country:US
Practice Address - Phone:707-639-4984
Practice Address - Fax:707-426-4875
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL40684156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic