Healthcare Provider Details

I. General information

NPI: 1275716029
Provider Name (Legal Business Name): WHALEN OPTICAL LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 E STATE ST
ROCKFORD IL
61108-2430
US

IV. Provider business mailing address

5970 E STATE ST
ROCKFORD IL
61108-2430
US

V. Phone/Fax

Practice location:
  • Phone: 815-395-1820
  • Fax: 815-395-9135
Mailing address:
  • Phone: 815-395-1820
  • Fax: 815-395-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN L REINGOLD
Title or Position: CLAIMS ADMINISTRATOR
Credential:
Phone: 815-399-0599