MEDICARE: DR. EDWARD LEONARD MONTWILL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046-008324	IL

General Provider Information

NPI Number	:	1225199623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD LEONARD MONTWILL O.D.

Provider Business Mailing Address
First Line	:	11749 SOUTHWEST HWY
Second Line	:	STE D
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1053
Country	:	US
Telephone Number	:	708-361-5236
Fax Number	:	708-361-5489

Provider Business Practice Location Address
First Line	:	11749 SOUTHWEST HWY
Second Line	:	SUITE C
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1053
Country	:	US
Telephone Number	:	708-361-5236
Fax Number	:	708-361-5489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	09/28/2018

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