Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046010887 | IL |
NPI | 1003299256 |
---|---|
Provider Name | Renee Rowley |
First Address | Bloomington, IL 61701-1784 |
Second Address | Bloomington, IL 61701-1784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 14/12/2016 |