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General NPI Number Information
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NPI Number | 1356686604
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Entity Type | Organization
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Legal Business Name | REDWELL & WIETIES EYECARE
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 905 W MEFFORD ST
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City | ROBINSON
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State | IL
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Zip | 62454-1065
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Country | US
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Telephone | 618-544-3525
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Fax | 618-544-3261
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Provider Business Mailing Address
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Address Line | P.O. BOX 658 905 W. MEFFORD ST.
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City | ROBINSON
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State | IL
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Zip | 62454-1065
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Country | US
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Telephone | 618-544-3525
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Fax | 618-544-3261
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Authorized Official
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Title or Position | PARTNER / OPTOMETRIST
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Name | MR. WILLIAM H BEDWELL
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Credential | O.D.
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Telephone | 618-544-3525
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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 | 046-008222
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-007815
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License Number State | IL
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