Organization
GENESEO VISION CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN J WILSON OD (OWNER)
(309) 944-5303
Entity
Organization
Contact information
Practice address
112 S CENTER ST, GENESEO, IL 61254-1338
(309) 944-5303
(309) 944-3465
Mailing address
112 S CENTER ST, GENESEO, IL 61254-1338
(309) 944-5303
(309) 944-3465
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
04600798
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007958
—
IL
Enumeration date
04/13/2015
Last updated
02/16/2024
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