Individual
DR. JOHN PHILLIP GYSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5901 N PROSPECT RD, SUITE #11, PEORIA, IL 61614-4358
(309) 692-2525
(309) 692-2584
Mailing address
5901 N PROSPECT RD STE 11, PEORIA, IL 61614-4337
(309) 692-2525
(309) 692-2584
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0046007961
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007961
—
IL
Enumeration date
08/17/2005
Last updated
10/28/2009
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