| |
1110 S Park Blvd, Freeport, IL 61032-4659 | |
(815) 232-1105 | |
(815) 232-3117 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 1110 S Park Blvd, Freeport, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1083801690 | NPI | - | NPPES |
1184682635 | Other | IL | NPI |
1437134509 | Other | IL | NPI |
1285635722 | Other | IL | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (Illinois) | Secondary |
152W00000X | Optometrist | (Illinois) | Secondary |
207W00000X | Ophthalmology | (Illinois) | Primary |
Mailing Address | Practice Location Address |
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1110 S Park Blvd, Freeport, IL 61032-4659 Ph: (815) 232-1105 | 1110 S Park Blvd, Freeport, IL 61032-4659 Ph: (815) 232-1105 |