Organization
PARK HILLS OPTICAL CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY JAMES O.D. (TREASURER/OWNER)
(815) 235-8083
Entity
Organization
Contact information
Practice address
1110 S PARK BLVD, FREEPORT, IL 61032-4659
(815) 235-8083
(815) 232-3117
Mailing address
1110 S PARK BLVD, FREEPORT, IL 61032-4659
(815) 235-8083
(815) 232-3117
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
IBT#1542-9199
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0442650001
DMERC PROVIDER
—
01
—
1184682635
NPI
IL
01
—
1285635722
NPI
IL
01
—
1437134509
NPI
IL
Enumeration date
10/11/2007
Last updated
10/11/2007
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