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General NPI Number Information
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NPI Number | 1285923680
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Entity Type | Organization
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Legal Business Name | BNL EYECARE INC.
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 2225 W MARKET ST VISION CENTER
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City | BLOOMINGTON
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State | IL
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Zip | 61705-5014
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Country | US
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Telephone | 309-829-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 2225 W MARKET ST VISION CENTER
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City | BLOOMINGTON
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State | IL
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Zip | 61705-5014
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Country | US
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Telephone | 309-829-0636
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DREW KLEIN
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Credential | O.D.
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Telephone | 847-962-1877
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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 | 046007201
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License Number State | IL
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