Individual
JOHN EVERD BROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1104 N VERMILION ST, CHITTICK FAMILY EYE CARE, DANVILLE, IL 61832-3094
(217) 442-2631
(217) 442-0119
Mailing address
1901 KENSINGTON KNOLL DR, CHAMPAIGN, IL 61822-8537
(217) 359-4111
(217) 459-9870
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-007703
IL
152WC0802X
Corneal and Contact Management Optometrist
046-007703
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16361
COLE MANAGED VISION
IL
01
—
216981
PERSONAL CARE
IL
Enumeration date
02/10/2006
Last updated
10/09/2014
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