Organization
TIM A BENGTSON O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM BENGTSON (OWNER)
(309) 833-4242
Entity
Organization
Contact information
Practice address
820 E JACKSON ST, MACOMB, IL 61455-2412
(309) 833-4242
Mailing address
820 E JACKSON ST, MACOMB, IL 61455-2412
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007904
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005584005
BLUE CROSS BLUE SHIELD
IL
05
—
046007904
—
IL
Enumeration date
08/13/2006
Last updated
05/08/2008
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