Individual
TIM A BENGTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
820 E JACKSON ST, MACOMB, IL 61455-2412
(309) 833-4242
Mailing address
820 E JACKSON ST, MACOMB, IL 61455-2412
(309) 833-4242
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007904
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007904
—
IL
Enumeration date
08/31/2007
Last updated
05/08/2008
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