Healthcare Provider Details

I. General information

NPI: 1508043290
Provider Name (Legal Business Name): JOHN J GEISER O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 5TH ST
LACON IL
61540-1206
US

IV. Provider business mailing address

114 5TH ST
LACON IL
61540-1206
US

V. Phone/Fax

Practice location:
  • Phone: 309-246-8177
  • Fax:
Mailing address:
  • Phone: 309-246-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number046006796
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER L CHIRCHIRILLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 309-246-8177