Geneseo Vision Center LLC
Optometrist in Geneseo, IL. Organization (NPI-2).
NPI number1073909354
StatusActive
Last updated in NPPESFeb 16, 2024
Details
- NPI
- 1073909354
- Entity type
- Organization (NPI-2)
- Legal business name
- Geneseo Vision Center LLC
- Organization subpart
- No
- Enumeration date
- Apr 13, 2015
- Certification date
- Feb 16, 2024
- Last updated
- Feb 16, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 04600798 | IL | Yes |
Practice location
112 S Center StGeneseo, IL 61254-1338
Phone 309-944-5303 · Fax 309-944-3465
Mailing address
112 S Center StGeneseo, IL 61254-1338
Phone 309-944-5303 · Fax 309-944-3465
Authorized official
Ryan J Wilson
Owner
3099445303
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