Individual
DR. CHASE AARON RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3121 S PARK AVE, HERRIN, IL 62948-3785
(618) 942-5465
Mailing address
3121 S PARK AVE., HERRIN, IL 62948
(618) 942-5465
(618) 942-7042
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010332
—
IL
Enumeration date
07/13/2010
Last updated
12/16/2015
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