Organization
ILLINI EYECARE MONTICELLO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHIRLEY ANN FISHER (OFFICE MANAGER)
(217) 762-2551
Entity
Organization
Contact information
Practice address
102 S CHARTER ST, MONTICELLO, IL 61856-1853
(217) 762-2551
Mailing address
102 S CHARTER ST, MONTICELLO, IL 61856-1853
(217) 762-2551
Taxonomy
Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
046007835
IL
152WX0102X
Occupational Vision Optometrist
Primary
046007835
IL
Other
Enumeration date
08/28/2007
Last updated
10/15/2009
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