Organization
ARSENEAU OPTICAL OF KANKAKEE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY TROST (PRES OPTICIAN)
(815) 933-5798
Entity
Organization
Contact information
Practice address
135 W COURT ST, KANKAKEE, IL 60901
(815) 933-5798
(815) 929-5760
Mailing address
135 W COURT ST, KANKAKEE, IL 60901
(815) 933-5798
(815) 929-5760
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
—
—
156FC0800X
Contact Lens Technician/Technologist
—
—
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL1521
MEDICARE PTAN
IL
Enumeration date
09/27/2006
Last updated
07/03/2013
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