Basic Information
| Provider Information | |||||||||
| NPI: | 1932156445 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GAILEY EYE CLINIC, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 757 | ||||||||
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| City: | BLOOMINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617020757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098295311 | ||||||||
| FaxNumber: | 3098278027 | ||||||||
| Practice Location | |||||||||
| Address1: | 1008 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617011784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098295311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 3098295311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1100X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Ophthalmic |
No ID Information.