Individual
TERRY VAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
131 S RANDOLPH ST, MACOMB, IL 61455-2207
(309) 833-5557
Mailing address
PO BOX 398, MACOMB, IL 61455-0398
(309) 833-5557
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0046 6378
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046006378
—
IL
01
—
371036657
FEDERAL TAX ID
—
Enumeration date
11/18/2005
Last updated
08/16/2024
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