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General NPI Number Information
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NPI Number | 1932156445
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Entity Type | Organization
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Legal Business Name | GAILEY EYE CLINIC, LTD
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 1008 N MAIN ST
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City | BLOOMINGTON
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State | IL
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Zip | 61701-1784
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Country | US
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Telephone | 309-829-5311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 757
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City | BLOOMINGTON
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State | IL
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Zip | 61702-0757
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Country | US
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Telephone | 309-829-5311
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Fax | 309-827-8027
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | REBECCA COX
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Credential |
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Telephone | 309-829-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number |
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License Number State | IL
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