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Organization

BRAIN-EYE EVOLUTION AT 730 NORTH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JODY L RICKETTS O.D. (OPTOMETRIST)
(847) 362-9900
Entity
Organization

Contact information

Practice address
730 N MILWAUKEE AVE, LIBERTYVILLE, IL 60048-1914
(847) 362-9900
Mailing address
730 N MILWAUKEE AVE, LIBERTYVILLE, IL 60048-1914
(847) 362-9900

Taxonomy

Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary

Other

Enumeration date
06/21/2016
Last updated
06/21/2016
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