Individual
DR. PETER JOHN POPOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
511 PALMYRA ST, DIXON, IL 61021-1953
(815) 284-2020
(815) 284-8326
Mailing address
511 PALMYRA ST, DIXON, IL 61021-1953
(815) 284-2020
(815) 284-8326
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010978
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010978
—
IL
01
—
F400568269
MEDICARE PTAN
IL
Enumeration date
06/07/2016
Last updated
10/08/2019
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