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NPI Code Detail

MEDICARE: WEBER MEDICAL CLINIC OPTICAL SHOP

MEDICARE: WEBER MEDICAL CLINIC OPTICAL SHOP
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
1156FX1800XOptician

General Provider Information

NPI Number : 1952572281
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEBER MEDICAL CLINIC OPTICAL SHOP
Provider Business Mailing Address
First Line : 1200 N EAST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2432
Country : US
Telephone Number : 618-395-5222
Fax Number :
Provider Business Practice Location Address
First Line : 1200 N EAST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2432
Country : US
Telephone Number : 618-395-5222
Fax Number :
Authorized Official
Title or Position : ADMINISTRATIVE SECRETARY
Name : MARGARET CARTMILL
Credential :
Telephone Number : 618-395-5222
Provider Enumeration Date : 03/14/2008
Last Update Date : 11/06/2008

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Directions to “WEBER MEDICAL CLINIC OPTICAL SHOP ” Practice Location

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