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General NPI Number Information
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NPI Number | 1003575762
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Entity Type | Organization
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Legal Business Name | BEHOLD STAR EYES LIMITED LIABILITY COMPANY UTANG EKPO SOLE MBR
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 3649 N VERMILION ST
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City | DANVILLE
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State | IL
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Zip | 61832-1118
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Country | US
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Telephone | 217-431-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 9 RIDGEVIEW ST APT 104
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City | DANVILLE
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State | IL
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Zip | 61832-1436
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | UTANG EKPO
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Credential | OD
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Telephone | 678-799-0857
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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 |
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License Number State |
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