Organization
WILLIAM B. WITTE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY TERESA RIEGER O.D. (OPTOMETRIST)
(309) 663-8581
Entity
Organization
Contact information
Practice address
2409 E WASHINGTON ST, BLOOMINGTON, IL 61704-4483
(309) 663-8581
(309) 663-0232
Mailing address
2409 E WASHINGTON ST, BLOOMINGTON, IL 61704-4483
(309) 663-8581
(309) 663-0232
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0282420001
DMERC SUPPLIER
IL
01
—
5784001
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/14/2007
Last updated
10/19/2007
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