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General NPI Number Information
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NPI Number | 1629013719
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Entity Type | Organization
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Legal Business Name | DILLMAN EYE CARE OPTICAL INC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 600 NORTH LOGAN AVENUE
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City | DANVILLE
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State | IL
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Zip | 61832-4375
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Country | US
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Telephone | 217-443-8112
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Fax | 217-443-6779
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Provider Business Mailing Address
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Address Line | 600 NORTH LOGAN AVENUE
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City | DANVILLE
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State | IL
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Zip | 61832-4375
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Country | US
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Telephone | 217-443-8112
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Fax | 217-443-6779
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DAVID M DILLMAN
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Credential | MD
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Telephone | 217-443-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3010 9434
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License Number State | IL
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