Healthcare Provider Details

I. General information

NPI: 1932831427
Provider Name (Legal Business Name): VISIDOC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W WASHINGTON ST STE 310
EAST PEORIA IL
61611-2559
US

IV. Provider business mailing address

111 W WASHINGTON ST STE 310
EAST PEORIA IL
61611-2559
US

V. Phone/Fax

Practice location:
  • Phone: 309-699-4715
  • Fax:
Mailing address:
  • Phone: 309-699-4715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN SEDGWICK
Title or Position: VICE PRESIDENT
Credential: CRNA
Phone: 309-699-4715