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General NPI Number Information
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NPI Number | 1073877890
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Entity Type | Organization
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Legal Business Name | DONAUSKY FAMILY VISION GROUP, SC
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 222 COLORADO AVE
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City | FRANKFORT
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State | IL
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Zip | 60423-1334
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Country | US
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Telephone | 815-464-7501
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Fax |
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Provider Business Mailing Address
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Address Line | 222 COLORADO AVE
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City | FRANKFORT
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State | IL
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Zip | 60423-1334
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Country | US
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Telephone | 815-464-7501
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Fax |
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. KENNETH DONAUSKY
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Credential |
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Telephone | 815-464-7501
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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 | 046-009000
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License Number State | IL
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