Individual
EILEEN MARIE WAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
840 35TH AVENUE PL, SUITE 101, MOLINE, IL 61265-8026
(309) 736-0808
Mailing address
840 35TH AVENUE PL, SUITE 101, MOLINE, IL 61265-8026
(309) 736-0808
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036051328
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036051328
—
IL
01
—
8100324
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/24/2005
Last updated
06/21/2010
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