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General NPI Number Information
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NPI Number | 1669570933
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Entity Type | Organization
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Legal Business Name | TRI COUNTY EYE CARE PC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 216 NW 1ST STREET
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City | GALVA
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State | IL
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Zip | 61434
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Country | US
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Telephone | 309-932-3615
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Fax | 309-932-2023
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Provider Business Mailing Address
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Address Line | 216 NW 1ST ST
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City | GALVA
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State | IL
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Zip | 61434
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Country | US
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Telephone | 309-932-3615
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Fax | 309-932-2023
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SALLY A BASS
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Credential |
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Telephone | 309-932-3615
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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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