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General NPI Number Information
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NPI Number | 1003146705
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Entity Type | Organization
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Legal Business Name | SUPERIOR PERFORMANCE EYE CARE SERVICES, INC
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 195 S 36TH ST
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City | QUINCY
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State | IL
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Zip | 62301-5801
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Country | US
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Telephone | 217-224-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 195 S 36TH ST
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City | QUINCY
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State | IL
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Zip | 62301-5801
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Country | US
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Telephone | 217-224-7732
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL LEONARD HAYDEN
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Credential | O.D.
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Telephone | 217-224-7732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046009104
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License Number State | IL
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