Organization
ILLINI OPTOMETRIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E FERGUSON OD (PRESIDENT)
(618) 446-8787
Entity
Organization
Contact information
Practice address
3300 GODFREY RD, GODFREY, IL 62035
(618) 466-8787
(618) 466-4703
Mailing address
PO BOX 5040, GODFREY, IL 62035
(618) 466-8787
(618) 466-4703
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
060005314
IL
Other
Enumeration date
05/07/2008
Last updated
05/07/2008
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