Individual
DR. TIMOTHY G. CUNDIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4900 N GLEN PARK PLACE RD STE C, PEORIA, IL 61614-4685
(309) 691-4500
Mailing address
4900 N GLEN PARK PLACE RD STE C, PEORIA, IL 61614-4685
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.010075
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
07/01/2008
Last updated
07/01/2008
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