Organization
GM REVELLE INC
Active
Other names
Vision Gallery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS E DETTMANN O.D. (OWNER)
(815) 436-1144
Entity
Organization
Contact information
Practice address
2820 PLAINFIELD RD, JOLIET, IL 60435-1167
(815) 436-1144
(815) 436-1260
Mailing address
2820 PLAINFIELD RD, JOLIET, IL 60435-1167
(815) 436-1144
(815) 436-1260
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007054
—
IL
01
—
9932299
BC/BS
IL
Enumeration date
08/31/2005
Last updated
04/30/2008
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