Provider Demographics
NPI:1346079662
Name:MARNERIS, ALEXANDROS GEORGE (OD)
Entity type:Individual
Prefix:
First Name:ALEXANDROS
Middle Name:GEORGE
Last Name:MARNERIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25150 W CHANNON DR UNIT 1146
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-4954
Mailing Address - Country:US
Mailing Address - Phone:815-661-2112
Mailing Address - Fax:
Practice Address - Street 1:12234 PALMDALE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9418
Practice Address - Country:US
Practice Address - Phone:760-843-9752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist