=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346079662
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDROS GEORGE MARNERIS OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2024
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12100 PALMDALE RD STE B10
-----------------------------------------------------
City | ADELANTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92301-6709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-246-2002
-----------------------------------------------------
Fax | 760-246-2016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25150 W CHANNON DR UNIT 1146
-----------------------------------------------------
City | CHANNAHON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60410-4954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-661-2112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 35804
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------