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General NPI Number Information
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NPI Number | 1831486901
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Entity Type | Individual
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Provider Name | DINITA COOLEY O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 6232 BROADWAY
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City | QUINCY
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State | IL
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Zip | 62305-6230
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Country | US
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Telephone | 217-771-1845
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Fax |
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Provider Business Mailing Address
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Address Line | 8309 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61615-2170
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Country | US
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Telephone | 309-693-9540
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Fax | 309-693-9542
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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 | 2011018493
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.010549
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License Number State | IL
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