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General NPI Number Information
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NPI Number | 1710180922
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Entity Type | Organization
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Legal Business Name | DR ERIC BOTTS & ASSOCIATES LLC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 1730 E JACKSON ST
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City | MACOMB
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State | IL
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Zip | 61455-2531
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Country | US
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Telephone | 309-836-3373
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Fax | 309-836-3375
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Provider Business Mailing Address
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Address Line | PO BOX 465 1730 E JACKSON ST
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City | MACOMB
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State | IL
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Zip | 61455-0465
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Country | US
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Telephone | 309-333-6344
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ERIC BOTTS
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Credential | OD
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Telephone | 309-333-6344
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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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