Healthcare Provider Details

I. General information

NPI: 1912560707
Provider Name (Legal Business Name): VEP IL OPTOMETRIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 STATE ROUTE 251
PERU IL
61354-1005
US

IV. Provider business mailing address

PO BOX 800148
KANSAS CITY MO
64180-0148
US

V. Phone/Fax

Practice location:
  • Phone: 815-224-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ERIC BIRKY
Title or Position: PRESIDENT
Credential:
Phone: 309-663-2700