Organization
MAPLESHADE VISION CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAYLAN WAYNE MOUSHON O.D. (OWNER)
(309) 243-5900
Entity
Organization
Contact information
Practice address
11825 STATE ROUTE 40, SUITE 101, DUNLAP, IL 61525-8842
(309) 243-5900
(309) 243-9852
Mailing address
11825 STATE ROUTE 40, SUITE 101, DUNLAP, IL 61525-8842
(309) 243-5900
(309) 243-9852
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0460088755
IL
Other
Enumeration date
02/23/2007
Last updated
08/01/2007
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