Organization
DENNIS M BRTVA
Active
Other names
Dr Dennis M Brtva & Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS M BRTVA O.D. (OWNER)
(309) 663-2211
Entity
Organization
Contact information
Practice address
801 W LAKE AVE, 300 EVERGREEN SQUARE, PEORIA, IL 61614-5951
(309) 686-0763
(309) 685-8809
Mailing address
801 W LAKE AVE, 300 EVERGREEN SQUARE, PEORIA, IL 61614-5951
(309) 686-0763
(309) 685-8809
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7221381
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
02/07/2006
Last updated
01/02/2008
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