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General NPI Number Information
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NPI Number | 1013905462
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Entity Type | Individual
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Provider Name | MARK PELLER O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 1025 S POWER RD
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City | MESA
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State | AZ
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Zip | 85206-5240
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Country | US
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Telephone | 480-325-6277
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Fax | 480-325-6278
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Provider Business Mailing Address
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Address Line | 220 N MCKEMY AVE
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City | CHANDLER
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State | AZ
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Zip | 85226-2654
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Country | US
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Telephone | 480-961-1865
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Fax | 480-961-4605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 928
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 698
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License Number State | AZ
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