Individual
DR. EDWARD LESLIE COLLOTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1505 EASTLAND DR, STE 2200, BLOOMINGTON, IL 61701-7910
(309) 662-7700
(309) 662-0829
Mailing address
1505 EASTLAND DR, STE 2200, BLOOMINGTON, IL 61701-7910
(309) 662-7700
(309) 662-0829
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05700231
BC/BS PROVIDER #
IL
Enumeration date
06/10/2005
Last updated
07/08/2007
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