Organization
ALLIANCE EYECARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA A RUSSELL (ASSISTANT COMPTROLLER)
(309) 828-7723
Entity
Organization
Contact information
Practice address
1228 TOWANDA AVE, BLOOMINGTON, IL 61701-3469
(309) 828-7723
Mailing address
1228 TOWANDA AVE, BLOOMINGTON, IL 61701-3469
(309) 828-7723
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05732032
BLUE CROSS BLUE SHIELD
IL
01
—
4718410001
DMERC
—
Enumeration date
12/22/2006
Last updated
10/16/2007
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