Individual
LAURA WILSHIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
8309 N KNOXVILLE AVE, STE. 1, PEORIA, IL 61615-2170
(309) 713-3664
(309) 693-9754
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
(309) 693-9754
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-011052
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046011052
—
IL
Enumeration date
08/02/2016
Last updated
08/02/2016
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