| |
1712 W Reynolds St, Pontiac, IL 61764-9695 | |
(309) 693-9540 | |
(309) 693-9754 |
Full Name | |
---|---|
Type | Facility |
Speciality | Durable Medical Equipment & Medical Supplies |
Location | 1712 W Reynolds St, Pontiac, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1255617924 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
8309 N Knoxville Ave, Peoria, IL 61615-2170 Ph: (309) 693-9540 | 1712 W Reynolds St, Pontiac, IL 61764-9695 Ph: (309) 693-9540 |