Individual
MRS. PATRICIA ANN CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 N 1ST ST, ROCKFORD, IL 61107-3900
(815) 965-2989
Mailing address
130 N 1ST ST, ROCKFORD, IL 61107-3900
(815) 965-2989
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
23903228
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295290001
BILLING PROVIDER
IL
Enumeration date
04/09/2008
Last updated
04/09/2008
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