Healthcare Provider Details

I. General information

NPI: 1073756490
Provider Name (Legal Business Name): VINTAGE OPTICAL BRIAN C SOMMER OD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S MAIN ST
MORTON IL
61550-2413
US

IV. Provider business mailing address

605 S MAIN ST
MORTON IL
61550-2413
US

V. Phone/Fax

Practice location:
  • Phone: 309-263-8611
  • Fax: 309-263-8926
Mailing address:
  • Phone: 309-263-8611
  • Fax: 309-263-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.007309
License Number StateIL

VIII. Authorized Official

Name: PAUL O VELTING
Title or Position: OWNER
Credential: OD
Phone: 309-263-8611