Healthcare Provider Details

I. General information

NPI: 1942281753
Provider Name (Legal Business Name): PAUL DANIEL DOYLE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 14TH AVE
MENDOTA IL
61342-1412
US

IV. Provider business mailing address

700 14TH AVE
MENDOTA IL
61342-1412
US

V. Phone/Fax

Practice location:
  • Phone: 815-539-6291
  • Fax: 815-539-3035
Mailing address:
  • Phone: 815-539-6291
  • Fax: 815-539-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: