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General NPI Number Information
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NPI Number | 1548381635
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Entity Type | Organization
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Legal Business Name | A & M OPTICAL
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 591 SOUTH EASTWOOD DR
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City | WOODSTOCK
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State | IL
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Zip | 60098-4631
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Country | US
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Telephone | 815-338-0107
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Fax | 815-338-5104
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Provider Business Mailing Address
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Address Line | 591 SOUTH EASTWOOD DR
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City | WOODSTOCK
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State | IL
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Zip | 60098-4631
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Country | US
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Telephone | 815-338-0107
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Fax | 815-338-5104
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | WILLIAM RAY ATKINSON
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Credential | O.D.
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Telephone | 815-338-0107
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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 | IL
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