MEDICARE: TAZEWELL COUNTY RESOURCE CENTERS INC

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	152WL0500X	Low Vision Rehabilitation Optometrist		IL

General Provider Information

NPI Number	:	1265431506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAZEWELL COUNTY RESOURCE CENTERS INC

Provider Business Mailing Address
First Line	:	111 W WASHINGTON ST
Second Line	:	SUITE 410
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-2532
Country	:	US
Telephone Number	:	309-698-4001
Fax Number	:	309-698-9227

Provider Business Practice Location Address
First Line	:	111 W WASHINGTON ST
Second Line	:	SUITE 410
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-2532
Country	:	US
Telephone Number	:	309-698-4001
Fax Number	:	309-698-9227

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. RONALD J HALE
Credential	:
Telephone Number	:	309-347-7148

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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