Jay Charles Black OD

NPI 1629113261 - Optometrist - 152W00000X

NPI Details
NPI 1629113261
Gender Male
Enumeration Date 02/21/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
5316 N SECOND STREET
LOVES PARK IL, 61111-5009, US
Phone (815) 877-6551
Fax (815) 877-4821
Business Location
5316 N SECOND STREET
LOVES PARK IL, 61111-5009, US
Phone (815) 877-6551
Fax (815) 877-4821
Toxanomy
Taxonomy Code 152W00000X
License State Illinois
License Number 466709
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According to our database, Dr. Jay Charles Black OD NPI is 1629113261, taxonomy code is 152W00000X and license number is 466709, license state is located at Illinois. Jay Charles Black OD physically located at 5316 N Second Street, Loves Park IL, 61111-5009. NPI Number Jay Charles Black OD has the Individual type.

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1629113261 NPI number is provided on an as is basis without warranty of any kind. 1629113261 is maintained by the National Plan & Provider Enumeration System. The contents of Jay Charles Black OD are for informational purposes only.