Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 046009163 | IL |
NPI | 1174717003 |
---|---|
Provider Name | Dr. Robert M Quilleash |
First Address | Peoria, IL 61613-1000 |
Second Address | Peoria, IL 61613-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 15/08/2012 |