| NPI | 1295802981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORSEY ELIZABETH HENDERSON Manager 217-698-9477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-009151) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008041) |
| 207W00000X Ophthalmology (Licence: IL 036-042254) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2019-10-22 |