Healthcare Provider Details

I. General information

NPI: 1790855831
Provider Name (Legal Business Name): ANDERSON EYE ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CLARENDON AVE SUITE 103
SAVOY IL
61874
US

IV. Provider business mailing address

713 W OREGON ST
URBANA IL
61801-4047
US

V. Phone/Fax

Practice location:
  • Phone: 217-355-7947
  • Fax: 217-355-8047
Mailing address:
  • Phone: 708-623-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042618867
License Number StateIL

VIII. Authorized Official

Name: BETTE ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 708-623-8213