Individual
MR. ROBERT EUGENE WOOLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
104 S OAK, SUITE A, PANA, IL 62557-1436
(217) 562-2512
(217) 562-2503
Mailing address
PO BOX 228, PANA, IL 62557-1436
(217) 562-2512
(217) 562-2503
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0520540001
DME PROVIDER NUMBER
IL
Enumeration date
12/19/2006
Last updated
03/24/2008
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