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General NPI Number Information
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NPI Number | 1114062288
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Entity Type | Individual
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Provider Name | JODI M ALBERT JODI M ALBERT
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 505 S NEIL ST 4
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City | CHAMPAIGN
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State | IL
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Zip | 61820-5231
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Country | US
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Telephone | 217-356-5787
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Fax | 217-356-0655
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Provider Business Mailing Address
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Address Line | 505 S NEIL ST SUITE NUMBER 4
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City | CHAMPAIGN
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State | IL
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Zip | 61820-5231
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Country | US
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Telephone | 217-356-5787
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Fax | 217-356-0655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046-008689
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License Number State | IL
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