Individual
GARY T. KOTELES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Mailing address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007329
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46007329
—
IL
Enumeration date
12/12/2006
Last updated
01/26/2010
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