Organization
LIGHTS PROSTHETIC EYES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY L LIGHT B.C.O., B.A.D.O. (PRESIDENT)
(309) 676-3663
Entity
Organization
Contact information
Practice address
1318 W CANDLETREE DR, STE 3, PEORIA, IL 61614-8509
(309) 676-3663
(309) 676-0359
Mailing address
1318 W CANDLETREE DR, STE 3, PEORIA, IL 61614-8509
(309) 676-3663
(309) 676-0359
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
203000116
IL
Other
Enumeration date
05/30/2006
Last updated
07/03/2009
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