Organization
WENDY'S EYEGLASS SHACK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY RUTH SMITH (CERTIFIED OPTICIAN)
(309) 693-0100
Entity
Organization
Contact information
Practice address
8424 N KNOXVILLE AVE, PEORIA, IL 61615-2032
(309) 693-0100
Mailing address
8424 N KNOXVILLE AVE, PEORIA, IL 61615-2032
(309) 693-0100
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
136295
IL
Other
Enumeration date
07/24/2008
Last updated
09/21/2010
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