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General NPI Number Information
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NPI Number | 1134274889
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Entity Type | Organization
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Legal Business Name | DRS. GANDOLFI & SWAFFORD L.L.C.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 1475 DILLEYS ROAD STE 4
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City | GURNEE
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State | IL
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Zip | 60031-1706
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Country | US
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Telephone | 847-856-3939
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Fax | 847-855-8821
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Provider Business Mailing Address
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Address Line | 1475 DILLEYS ROAD STE 4
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City | GURNEE
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State | IL
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Zip | 60031-1706
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Country | US
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Telephone | 847-856-3939
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Fax | 847-855-8821
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BRENT GANDOLFI
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Credential | O.D.
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Telephone | 847-856-3939
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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 | 049007799
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License Number State | IL
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