| NPI | 1144679853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KAY HECKMAN Manager 217-355-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 04600839) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008936) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2023-07-12 |