Organization
FAMILY EYE CARE OF PONTIAC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REID ALLEN PETTIT OD (OWNER)
(815) 842-4304
Entity
Organization
Contact information
Practice address
320 N LADD ST, PONTIAC, IL 61764-1612
(815) 842-4304
(815) 844-5495
Mailing address
320 N LADD ST, PONTIAC, IL 61764-1612
(815) 842-4304
(815) 844-5495
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05332011
BLUE CROSS
—
01
—
4991920001
DME
—
01
—
DB0240
RAILROAD
—
Enumeration date
08/01/2005
Last updated
07/21/2022
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