Individual
DR. WINONA MARIE VAN HOUTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1705 W MORTON AVE, JACKSONVILLE, IL 62650-2719
(217) 245-6070
Mailing address
4891 SMITH RD, PLEASANT PLAINS, IL 62677-3997
(217) 361-6286
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.009980
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009980
—
IL
01
—
138476
HEALTH ALLIANCE
—
05
—
310350509
—
MO
01
—
IL9980
EYEMED
—
01
—
P00418696, CA2196
MEDICARE RAILROAD
—
Enumeration date
07/10/2007
Last updated
01/28/2022
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