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General NPI Number Information
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NPI Number | 1386990562
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Entity Type | Organization
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Legal Business Name | PRAIRIE EYECARE CENTER, LTD
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 3272 SYCAMORE RD
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City | DEKALB
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State | IL
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Zip | 60115-9621
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Country | US
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Telephone | 815-756-3701
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Fax |
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Provider Business Mailing Address
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Address Line | 3272 SYCAMORE RD
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City | DEKALB
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State | IL
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Zip | 60115-9621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. LORA CARTMELL
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Credential |
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Telephone | 630-334-7855
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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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