Tara N. Van De Wyngaerde, O.d., P.c.

NPI 1215128806 - Optometrist - 152W00000X

NPI Details
NPI 1215128806
Enumeration Date 08/07/2007
Last Updated 02/25/2011
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name TARA NICOLE TARA
Position OWER/OPTOMETRIST
Phone (815) 539-6291
Fax (815) 539-3035
Practice Location
700 14TH AVE
MENDOTA IL, 61342-1412, US
Phone (815) 539-6291
Fax (815) 539-3035
Business Location
700 14TH AVE
MENDOTA IL, 61342-1412, US
Phone (815) 539-6291
Fax (815) 539-3035
Toxanomy
Taxonomy Code 152W00000X
License State Illinois
License Number 046009989
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According to our database, Tara N. Van De Wyngaerde, O.d., P.c. NPI is 1215128806, taxonomy code is 152W00000X and license number is 046009989, license state is located at Illinois. Tara N. Van De Wyngaerde, O.d., P.c. physically located at 700 14th Ave, Mendota IL, 61342-1412. NPI Number 1033115704 has the healthcare provider type.

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1215128806 NPI number is provided on an as is basis without warranty of any kind. 1215128806 is maintained by the National Plan & Provider Enumeration System. The contents of Tara N. Van De Wyngaerde, O.d., P.c. are for informational purposes only.