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General NPI Number Information
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NPI Number | 1104926674
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Entity Type | Organization
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Legal Business Name | GREENVILLE EYEGLASS & CONTACTS INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 216 N THIRD ST STE B
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City | GREENVILLE
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State | IL
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Zip | 62246-1004
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Country | US
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Telephone | 618-664-9101
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Fax | 618-664-9657
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Provider Business Mailing Address
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Address Line | 216 N THIRD ST STE B
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City | GREENVILLE
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State | IL
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Zip | 62246-1004
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Country | US
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Telephone | 618-664-9101
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Fax | 618-664-9657
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMY LILE
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Credential |
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Telephone | 618-664-9101
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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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