| NPI | 1568644466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA ALLEN Access Manager 309-322-6892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2021-06-10 |