Individual
DR. STACY ANNE TWENHAFEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1351 HICKORY POINT DR, SUITE B, FORSYTH, IL 62535-1098
(217) 875-3724
(217) 875-3840
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
(309) 693-9754
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009713
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009713
—
IL
Enumeration date
01/24/2007
Last updated
01/13/2014
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