| |
110 E Main St, Dwight, IL 60420-1320 | |
(815) 584-5148 | |
(815) 828-2020 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 110 E Main St, Dwight, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1235458761 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 046007155 (Illinois) | Primary |
Mailing Address | Practice Location Address |
---|---|
110 E Main St # 151, Dwight, IL 60420-1320 Ph: (815) 584-5148 | 110 E Main St, Dwight, IL 60420-1320 Ph: (815) 584-5148 |