Individual
ANDREW IBISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1310 DADRIAN PROF PARK, GODFREY, IL 62035-1685
(618) 433-5005
(618) 467-1053
Mailing address
PO BOX 207163, DALLAS, TX 75320-7154
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.011262
IL
Other
Enumeration date
11/30/2018
Last updated
12/17/2018
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