Provider Demographics
NPI:1154701381
Name:MARK DILL OD PLC
Entity type:Organization
Organization Name:MARK DILL OD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:NERNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-337-1772
Mailing Address - Street 1:501 W RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-9314
Mailing Address - Country:US
Mailing Address - Phone:515-337-1601
Mailing Address - Fax:515-337-1774
Practice Address - Street 1:501 W RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-9314
Practice Address - Country:US
Practice Address - Phone:515-337-1601
Practice Address - Fax:515-337-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty