Healthcare Provider Details

I. General information

NPI: 1235104035
Provider Name (Legal Business Name): KEHOE EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-L PLAZA SUITE 35
GALESBURG IL
61401
US

IV. Provider business mailing address

4-L PLAZA SUITE 35
GALESBURG IL
61401
US

V. Phone/Fax

Practice location:
  • Phone: 309-343-1179
  • Fax: 309-343-5287
Mailing address:
  • Phone: 309-343-1179
  • Fax: 309-343-5287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: PETER H KOHOE
Title or Position: PRESIDENT
Credential: OD
Phone: 309-343-1179