Individual
JUSTIN GROENNERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
201 W SAINT LOUIS ST, LEBANON, IL 62254-1515
(618) 537-6356
Mailing address
201 W SAINT LOUIS ST, LEBANON, IL 62254-1515
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.011438
IL
Other
Enumeration date
06/19/2020
Last updated
06/19/2020
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