Healthcare Provider Details

I. General information

NPI: 1265431506
Provider Name (Legal Business Name): TAZEWELL COUNTY RESOURCE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W WASHINGTON ST SUITE 410
EAST PEORIA IL
61611-2532
US

IV. Provider business mailing address

111 W WASHINGTON ST SUITE 410
EAST PEORIA IL
61611-2532
US

V. Phone/Fax

Practice location:
  • Phone: 309-698-4001
  • Fax: 309-698-9227
Mailing address:
  • Phone: 309-698-4001
  • Fax: 309-698-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. RONALD J HALE
Title or Position: PRESIDENT CEO
Credential:
Phone: 309-347-7148