Gm Revelle INC

NPI #1972597342 in Joliet, Illinois

Provider Information

NPI Number: 1972597342
Entity Type: Organization
Organization Name: Gm Revelle INC
Primary Specialty: Optometrist
Enumeration Date: Aug 31, 2005
Last Updated: Apr 30, 2008

Practice Location

Address: 2820 PLAINFIELD RD
City: Joliet
State: Illinois
ZIP Code: 60435-1167
Phone: (815) 436-1144

Authorized Official

Name: DR. DENNIS E DETTMANN, O.D.
Title: OWNER
Phone: (815) 436-1144

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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