Healthcare Provider Details

I. General information

NPI: 1669570933
Provider Name (Legal Business Name): TRI COUNTY EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 NW 1ST STREET
GALVA IL
61434
US

IV. Provider business mailing address

216 NW 1ST ST
GALVA IL
61434
US

V. Phone/Fax

Practice location:
  • Phone: 309-932-3615
  • Fax: 309-932-2023
Mailing address:
  • Phone: 309-932-3615
  • Fax: 309-932-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SALLY A BASS
Title or Position: OFFICE MANAGER
Credential:
Phone: 309-932-3615