Healthcare Provider Details

I. General information

NPI: 1851469431
Provider Name (Legal Business Name): HW HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 WYLIE DR
NORMAL IL
61761-5405
US

IV. Provider business mailing address

480 WYLIE DR
NORMAL IL
61761-5405
US

V. Phone/Fax

Practice location:
  • Phone: 309-938-4949
  • Fax: 312-327-7621
Mailing address:
  • Phone: 309-938-4949
  • Fax: 312-327-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ERIN BOX
Title or Position: PRESIDENT
Credential:
Phone: 309-808-3112