Individual
ADEYINKA A ADEWALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3300 GODFREY RD, GODFREY, IL 62035-2558
(618) 466-8787
(618) 466-4703
Mailing address
3300 GODFREY RD, GODFREY, IL 62035-2558
(618) 466-8787
(618) 466-4703
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009191
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467533661
—
IL
Enumeration date
10/17/2006
Last updated
09/02/2010
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