| NPI | 1548811391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK DENNIS KVITLE Owner/Optometrist 217-231-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |