Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 114 5th St, Lacon, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1508043290 | NPI | - | NPPES |
046006796 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | 046006796 (Illinois) | Primary |
Mailing Address | Practice Location Address |
---|---|
114 5th St, Lacon, IL 61540-1206 Ph: (309) 246-8177 | 114 5th St, Lacon, IL 61540-1206 Ph: (309) 246-8177 |