Healthcare Provider Details

I. General information

NPI: 1376554857
Provider Name (Legal Business Name): COLLEEN M GOVEKAR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 N MAIN ST
WHEATON IL
60187-3190
US

IV. Provider business mailing address

2015 N MAIN ST
WHEATON IL
60187-3152
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-8250
  • Fax: 630-668-8916
Mailing address:
  • Phone: 630-668-8250
  • Fax: 630-668-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009884
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046009884
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: