Organization
J.E. TALLIS DBA AMERICAN VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISANN TALLIS (OFFICE MANAGER)
(309) 827-8434
Entity
Organization
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
046007271
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007271
—
IL
01
—
934801
MEDICARE ID
IL
Enumeration date
04/30/2008
Last updated
07/14/2008
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