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1124060074
RANDY L LIGHT
PEORIA, IL
NPI
1124060074
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
156FX1700X Technician/Technologist Ocularist
(Licence: IL 203.000116)
Enumeration Date
2006-06-12
Last Update Date
2009-07-03
Business Address
MR. RANDY L LIGHT B.C.O., B.A.D.O.
1318 W CANDLETREE DR SUITE 3
PEORIA, IL 61614-8508
Phone number: 309-676-3663
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Mailing Address
MR. RANDY L LIGHT B.C.O., B.A.D.O.
1318 W CANDLETREE DR SUITE 3
PEORIA, IL 61614-8508
Phone number: 309-676-3663
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