MEDICARE: DANIEL R DOYLE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046006661	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033104757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL R DOYLE OD

Provider Business Mailing Address
First Line	:	67 PUBLIC SQ
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1755
Country	:	US
Telephone Number	:	309-734-3108
Fax Number	:	309-734-6988

Provider Business Practice Location Address
First Line	:	67 PUBLIC SQ
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1755
Country	:	US
Telephone Number	:	309-734-3108
Fax Number	:	309-734-3108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	05/25/2010

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Directions to “ DANIEL R DOYLE OD” Practice Location

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