MEDICARE: DR. DAVID R MORGRET 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	046006761	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180025768	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	346-000971	OTHER	IL	IL CONTROLLED SUBSTANCE
3	0005807323	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1922109172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R MORGRET O.D.

Provider Business Mailing Address
First Line	:	8309 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-2170
Country	:	US
Telephone Number	:	309-693-9540
Fax Number	:	309-693-9542

Provider Business Practice Location Address
First Line	:	331 W 1ST DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5207
Country	:	US
Telephone Number	:	217-422-3881
Fax Number	:	217-422-3883

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. DAVID R MORGRET O.D.” Practice Location

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