Individual
DR. IVETTA S DACCACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
725 S 14TH ST, PEKIN, IL 61554-5073
(309) 353-6660
Mailing address
725 S 14TH ST, PEKIN, IL 61554-5073
(309) 353-6660
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009676
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009676
—
IL
01
—
7215175
BCBS
IL
Enumeration date
09/30/2005
Last updated
05/20/2013
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