Aeg Delaware Professional PA

NPI #1528741543 in Alton, Illinois

Provider Information

NPI Number: 1528741543
Entity Type: Organization
Organization Name: Aeg Delaware Professional PA
Subpart: Yes (part of a larger organization)
Parent Organization: AEG DELAWARE PROFESSIONAL PA
Primary Specialty: Optometrist
Enumeration Date: Aug 8, 2023
Last Updated: Aug 17, 2023

Practice Location

Address: 111 E 4TH ST STE 440
City: Alton
State: Illinois
ZIP Code: 62002-6206
Phone: (618) 462-9818

Authorized Official

Name: MELISSA K ALLISON
Title: SR. DIRECTOR RCM/MVC
Phone: (618) 462-9818

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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