Individual
PETER H KEHOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
35 4L PLZ, GALESBURG, IL 61401-4501
(309) 343-1179
(309) 343-5287
Mailing address
35 4L PLZ, GALESBURG, IL 61401-4501
(309) 343-1179
(309) 343-5287
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007889
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007889
—
IL
01
—
0476210001
MEDICARE DME
IL
01
—
04821476
BCBS
IL
Enumeration date
08/25/2005
Last updated
08/12/2011
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