Healthcare Provider Details

I. General information

NPI: 1033290762
Provider Name (Legal Business Name): VELD VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 E EXCHANGE ST
CRETE IL
60417-3454
US

IV. Provider business mailing address

1080 E EXCHANGE ST
CRETE IL
60417-3454
US

V. Phone/Fax

Practice location:
  • Phone: 708-672-3937
  • Fax: 708-672-3940
Mailing address:
  • Phone: 708-672-3937
  • Fax: 708-672-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008221
License Number StateIL

VIII. Authorized Official

Name: DR. PAUL ALLEN VELD
Title or Position: OPTOMETRIST
Credential: OD
Phone: 708-672-3937