Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046011418 | IL |
NPI | 1013530799 |
---|---|
Provider Name | Monika Gil |
First Address | Palos Hills, IL 60465-3910 |
Second Address | Matteson, IL 60443-2318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2020 |
Last Update Date | 28/05/2020 |