MEDICARE: DR. MARK GUY CONDELL OD

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
1	152W00000X	Optometrist	OPT7778T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619959079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK GUY CONDELL OD

Provider Business Mailing Address
First Line	:	27201 REGIO
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-3206
Country	:	US
Telephone Number	:	949-701-2576
Fax Number	:

Provider Business Practice Location Address
First Line	:	27201 REGIO
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-3206
Country	:	US
Telephone Number	:	949-701-2576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	04/03/2019

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