Individual
DEREK HENNIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1700 18TH ST, CHARLESTON, IL 61920-3607
(217) 345-6600
(217) 345-6622
Mailing address
1700 18TH ST, CHARLESTON, IL 61920-3607
(217) 345-6600
(217) 345-6622
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011094
IL
Other
Enumeration date
06/06/2017
Last updated
06/06/2017
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