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Organization
PEORIA EYE CLINIC, LTD
Active
Organization
PEORIA EYE CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C NELSON MD (PRESIDENT)
(309) 676-2020
Entity
Organization
Contact information
Practice address
2422 W NEBRASKA AVE, PEORIA, IL 61604-3112
(309) 676-2020
(309) 673-2020
Mailing address
2422 W NEBRASKA AVE, PEORIA, IL 61604-3112
(309) 676-2020
(309) 673-2020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37103572
FEDERAL TAX ID NUMBER
IL
Enumeration date
11/19/2005
Last updated
08/22/2020
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