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General NPI Number Information
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NPI Number | 1033290762
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Entity Type | Organization
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Legal Business Name | VELD VISION CENTER
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 1080 E EXCHANGE ST
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City | CRETE
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State | IL
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Zip | 60417-3454
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Country | US
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Telephone | 708-672-3937
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Fax | 708-672-3940
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Provider Business Mailing Address
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Address Line | 1080 E EXCHANGE ST
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City | CRETE
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State | IL
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Zip | 60417-3454
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Country | US
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Telephone | 708-672-3937
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Fax | 708-672-3940
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. PAUL ALLEN VELD
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Credential | OD
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Telephone | 708-672-3937
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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 | 046008221
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License Number State | IL
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