Individual
DR. REID ALLEN PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
320 N LADD ST, PONTIAC, IL 61764-1612
(815) 842-4304
(845) 844-5495
Mailing address
320 N LADD ST, PONTIAC, IL 61764-1612
(815) 842-4304
(845) 844-5495
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-007222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004036
HEALTH ALLIANCE
—
01
—
046-007222
OSF
—
05
—
046-007222
—
IL
01
—
05332011
BLUE CROSS
IL
01
—
05332011
BLUE CROSS
—
01
—
4991920001
DME
—
01
—
499192011
MEDICARE DURABLE MEDICAL
IL
01
—
P00125958
RAILROAD
—
01
—
T37728
VSP
—
Enumeration date
07/19/2005
Last updated
03/07/2023
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