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General NPI Number Information
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NPI Number | 1417007378
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Entity Type | Organization
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Legal Business Name | ONE OR TWO, LTD.
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 05/26/2011
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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 | 815-756-3700
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Fax | 815-756-3701
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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 | 815-756-3700
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Fax | 815-756-3701
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RANDALL D BURGGRAF
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Credential | O.D.
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Telephone | 815-756-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 00466713
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License Number State | IL
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