| NPI | 1679166953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON LANG Billing Administrator 217-698-3030 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2021-02-17 |