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General NPI Number Information
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NPI Number | 1972529360
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Entity Type | Individual
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Provider Name | MARK R. DILL O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 501 W RIVERSIDE RD
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City | AMES
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State | IA
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Zip | 50010-9314
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Country | US
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Telephone | 406-234-2911
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Fax | 515-337-1774
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Provider Business Mailing Address
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Address Line | 501 W RIVERSIDE RD
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City | AMES
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State | IA
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Zip | 50010-9314
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Country | US
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Telephone | 406-234-2911
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Fax | 515-337-1774
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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 | 735
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License Number State | MT
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