Healthcare Provider Details

I. General information

NPI: 1316932171
Provider Name (Legal Business Name): MICHAEL GERALD HOERRES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 CROSSTOWN AVE
SILVIS IL
61282-1651
US

IV. Provider business mailing address

704 CROSSTOWN AVE
SILVIS IL
61282-1651
US

V. Phone/Fax

Practice location:
  • Phone: 309-796-1444
  • Fax: 309-796-1496
Mailing address:
  • Phone: 309-796-1444
  • Fax: 309-796-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008302
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number152-01893
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: