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Organization

LIGHTS PROSTHETIC EYES INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RANDY L LIGHT BCO (PRESIDENT)
(309) 676-3663
Entity
Organization

Contact information

Practice address
1736 E SUNSHINE ST, SUITE 404, SPRINGFIELD, MO 65804-1343
(417) 889-0988
Mailing address
1318 W CANDLETREE DR, SUITE 3, PEORIA, IL 61614-8508
(309) 676-3663

Taxonomy

Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
17065569
MO

Other

Enumeration date
07/03/2008
Last updated
07/09/2008
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