Individual
DR. BENNA KAYE DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
960 S COMMERCIAL ST, HARRISBURG, IL 62946-2637
(618) 253-7057
(618) 252-1632
Mailing address
PO BOX 488, HARRISBURG, IL 62946-0488
(618) 253-7057
(618) 252-1632
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-007542
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046-007542
—
IL
05
—
046007542
—
IL
Enumeration date
07/13/2006
Last updated
03/30/2009
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