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NPI Code Detail

MEDICARE: DR. MARK WILLIAM ACTON DO

MEDICARE: DR. MARK WILLIAM ACTON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist34182TLGCA

General Provider Information

NPI Number : 1558834622
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK WILLIAM ACTON DO
Provider Business Mailing Address
First Line : 4427 KATHERINE AVE
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91423-2706
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6765 LANKERSHIM BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91606-1614
Country : US
Telephone Number : 818-982-0076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2019
Last Update Date : 01/10/2019

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