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General NPI Number Information
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NPI Number | 1063201788
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Entity Type | Organization
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Legal Business Name | VEP IL OPTOMETRIC LLC
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 10900 A LINCOLN TRAIL
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208
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Country | US
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Telephone | 309-808-3112
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Fax |
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Provider Business Mailing Address
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Address Line | 811 S MAIN STREET 7TH FLOOR ATTN: 800148
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City | KANSAS CITY
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State | MO
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Zip | 64180-0148
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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 | OPTOMETRIST
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Name | PRISCILLA PAPPAS
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Credential |
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Telephone | 217-877-7900
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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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