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ERNEST DALE BROCK O.D., NPI 1538161708

Optometrist in WEST FRANKFORT, IL

Last Updated on : Feb 17,2009

About ERNEST DALE BROCK (NPI 1538161708)


ERNEST DALE BROCK is an Optometrist provider in WEST FRANKFORT, United States. His medical specialization is Optometrist .

1538161708 is NPI number of ERNEST DALE BROCK.

ERNEST DALE BROCK's primary taxonomy code based on NPI Lookup is 152W00000X with license number 046-006814. This taxonomy code refers to Optometrist.

ERNEST DALE BROCK has more than 16 years of experience.

ERNEST DALE BROCK current practice location address is 202 E CLARK ST, WEST FRANKFORT, IL. ERNEST DALE BROCK can be reached out via phone at 618-937-3126 and via fax at 618-937-3344 .

You can also correspond with ERNEST DALE BROCK through mail at mailing address 202 E CLARK ST, WEST FRANKFORT, IL, United States. Mailing address contact number is 618-937-3126.

The enumeration date of ERNEST DALE BROCK is 01-Jun-2005. The provider is registered as an Individual and the NPI record was last updated 13 years ago.

1538161708 NPI Information

Name ERNEST DALE BROCK
National Provider Id (NPI) 1538161708
Entity Type Individual
Gender M
Credential O.D.
Practice Address 202 E CLARK ST,
WEST FRANKFORT, IL, United States
Practice Telephone 618-937-3126
Practice Fax Number 618-937-3344
Mailing Address 202 E CLARK ST ,
WEST FRANKFORT, IL, United States
Mailing Telephone 618-937-3126
Mailing Fax Number 618-937-3344
Enumeration Date 01-Jun-2005
Last Updated Date 17-Feb-2009

ERNEST DALE BROCK (NPI 1538161708) Primary Taxonomy Information

Primary Taxonomy Code Clasification License Number License State
Y 152W00000X Optometrist 046-006814 IL

Additional Identifiers

Identifier Type/Code Identifier State Identifier Issuer
0705620001 MEDICARE NSC (07) IL
234570 MEDICARE UPIN (02) IL

ERNEST DALE BROCK (NPI 1538161708) Office Location

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FAQs

Whose NPI Number is 1538161708?

1538161708 is the NPI number of ERNEST DALE BROCK.

What is the specialty for ERNEST DALE BROCK?

The Specialty of ERNEST DALE BROCK is Optometrist.

NPI number meaning

Field Name Field Value
NPI 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Mailing Address The mailing address of the provider being identified contains First line, Second Line, City name, State name, Postal code, and Country code.
Provider Business Mailing Address Telephone Number The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider Business Practice Location Address Telephone Number The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number The fax number associated with the location address of the provider being identified.
Provider Enumeration Date The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date The date that a record was last updated or changed.
Authorized Official Telephone Number The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy Taxonomy Description of the Healthcare Provider.
Provider License Number Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
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