Organization
KERN OPTOMETRIC ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD C KERN OD (OPTOMETRIST)
(309) 682-6244
Entity
Organization
Contact information
Practice address
4408 N KNOXVILLE AVE, SUITE C, PEORIA, IL 61614
(309) 682-6214
(309) 682-6236
Mailing address
4408 N KNOXVILLE AVE, SUITE C, PEORIA, IL 61614
(309) 682-6214
(309) 682-6236
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007198
IL
152W00000X
Optometrist
0467198
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007198
—
IL
01
—
1497812242
NPI INDIVIDUAL CROSSOVER
—
Enumeration date
12/04/2007
Last updated
05/07/2013
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