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Individual

DR. THEODORE E BOGART

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
WEST ROUTE 16, SHELBYVILLE, IL 62565-0199
(217) 774-4422
(217) 774-4722
Mailing address
PO BOX 199, SHELBYVILLE, IL 62565-0199
(217) 774-4422
(217) 774-4722

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007165
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046007165
IL
Enumeration date
10/25/2006
Last updated
12/19/2012
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