Healthcare Provider Details

I. General information

NPI: 1932156445
Provider Name (Legal Business Name): GAILEY EYE CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N MAIN ST
BLOOMINGTON IL
61701-1784
US

IV. Provider business mailing address

PO BOX 757
BLOOMINGTON IL
61702-0757
US

V. Phone/Fax

Practice location:
  • Phone: 309-829-5311
  • Fax:
Mailing address:
  • Phone: 309-829-5311
  • Fax: 309-827-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name: REBECCA COX
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 309-829-5311