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General NPI Number Information
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NPI Number | 1831182328
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Entity Type | Individual
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Provider Name | ELISE M CORGIAT OD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 1802 N DIVISION ST STE 205
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City | MORRIS
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State | IL
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Zip | 60450-3134
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Country | US
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Telephone | 815-942-3042
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Fax | 815-942-3062
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Provider Business Mailing Address
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Address Line | 200 W DAKOTA ST
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City | SPRING VALLEY
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State | IL
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Zip | 61362-1906
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Country | US
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Telephone | 815-663-8281
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Fax | 815-663-8190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 222000012
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License Number State | IL
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