Individual
DR. JAY E TALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
915 N MAIN ST, BLOOMINGTON, IL 61701-3043
(309) 827-8434
(309) 828-6741
Mailing address
915 N MAIN ST, BLOOMINGTON, IL 61701-3043
(309) 827-8434
(309) 828-6741
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-007271
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007271
—
IL
Enumeration date
08/14/2006
Last updated
11/28/2014
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