Mapleshade Vision Center Inc.

NPI #1891820312 in Dunlap, Illinois

Provider Information

NPI Number: 1891820312
Entity Type: Organization
Organization Name: Mapleshade Vision Center Inc.
Primary Specialty: Optometrist
Enumeration Date: Feb 23, 2007
Last Updated: Aug 1, 2007

Practice Location

Address: 11825 STATE ROUTE 40
Address 2: SUITE 101
City: Dunlap
State: Illinois
ZIP Code: 61525-8842
Phone: (309) 243-5900

Authorized Official

Name: DR. GAYLAN WAYNE MOUSHON, O.D.
Title: OWNER
Phone: (309) 243-5900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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