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Organization

DR FORECKI AND ASSOCIATES, LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DIANE G FORECKI OD (OPTOMETRIST/PRESIDENT)
(239) 229-6423
Entity
Organization

Contact information

Practice address
137 W NORTH AVE, NORTHLAKE, IL 60164-2316
(239) 229-6423
Mailing address
13326 ISLAND RD, FORT MYERS, FL 33905-1805
(239) 229-6423

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
046-007557
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046007557
IL
Enumeration date
01/16/2008
Last updated
01/01/2015
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