| NPI | 1942483664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN M FOWELL President 815-226-4990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: IL 036073359) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 042006794) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2017-07-06 |