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>> Ophthalmology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1073603130

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
10 W 3RD ST  STERLING, IL 61081-3503 US
Tel: 815-625-4790  Fax: --

Contact information for business:
101 E MILLER RD  STERLING, IL 61081-1252 US
Tel: 815-625-4790  Fax: --

Registration Information:
NPI: 1073603130
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207W00000XAllopathic & Osteopathic Physicians

Legacy codes, insurance codes and state license numbers:



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