Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | IL046-009361 | IL |
NPI | 1003924945 |
---|---|
Provider Name | Dr. Donald D Loconte |
First Address | Frankfort, IL 60423-1280 |
Second Address | Frankfort, IL 60423-1280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 22/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212298 | MEDICARE GROUP NUMBER (01) | IL |
U86311 | (02) | IL |