Healthcare Provider Details

I. General information

NPI: 1033781562
Provider Name (Legal Business Name): SHWETA R HARVI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3287 COURT ST
PEKIN IL
61554-6208
US

IV. Provider business mailing address

8309 N KNOXVILLE AVE
PEORIA IL
61615-2170
US

V. Phone/Fax

Practice location:
  • Phone: 309-353-9313
  • Fax: 309-353-4962
Mailing address:
  • Phone: 309-693-9540
  • Fax: 309-693-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-011510
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: