MEDICARE: DR. ELLVIN JOHN MAR O.D.

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	007221	NY

General Provider Information

NPI Number	:	1790965101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLVIN JOHN MAR O.D.

Provider Business Mailing Address
First Line	:	834 FORT SALONGA RD STE D
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-3157
Country	:	US
Telephone Number	:	631-757-4440
Fax Number	:	631-757-4593

Provider Business Practice Location Address
First Line	:	834 FORT SALONGA RD STE D
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-3157
Country	:	US
Telephone Number	:	631-757-4440
Fax Number	:	631-757-4593

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

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	07/05/2016

Similar Medicare Providers

1922075423 — NORTHPORT OPTICAL CENTER INC.
Practice Location Address:

834 FORT SALONGA RD
NORTHPORT, NY
11768-3157

Practice Phone: 631-757-4440
Practice Fax: 631-757-4593

1376510503 — DR. MICHAEL TANENBAUM O.D.
Practice Location Address:

834 FORT SALONGA RD
NORTHPORT, NY
11768-3157

Practice Phone: 631-757-4440
Practice Fax: 631-757-4593

1770776197 — DR. GRACE TAN O.D.
Practice Location Address:

834 FORT SALONGA RD STE D
NORTHPORT, NY
11768-3157

Practice Phone: 631-757-4440
Practice Fax: 631-757-4593

1770973968 — TAN & MAR OPTOMETRY
Practice Location Address:

834 FORT SALONGA RD , SUITE D
NORTHPORT, NY
11768-3157

Practice Phone: 631-757-4440
Practice Fax: 631-757-4593

1679579189 — DR. LYNN ANNE FINNEGAN O.D.
Practice Location Address:

NORTHPORT VAMC-OPTOMETRY SERVICE , 79 MIDDLEVILE RD
NORTHPORT, NY
11768-2200

Practice Phone: 631-261-4400
Practice Fax:

1225035876 — ALAN R LAMPERT M.D.
Practice Location Address:

325 MAIN ST
NORTHPORT, NY
11768-1790

Practice Phone: 631-261-4445
Practice Fax: 631-261-3710

Directions to “ DR. ELLVIN JOHN MAR O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.