Organization
E DALE BROCK OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST DALE BROCK OD PC (PRESIDENT)
(618) 937-3126
Entity
Organization
Contact information
Practice address
202 E CLARK ST, WEST FRANKFORT, IL 62896-2706
(618) 937-3126
(618) 937-3344
Mailing address
202 E CLARK ST, WEST FRANKFORT, IL 62896-2706
(618) 937-3126
(618) 937-3344
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
12/06/2007
Last updated
09/02/2009
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