E Dale Brock OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

E DALE BROCK OD PC

Practice address

202 E Clark St
West Frankfort, IL 62896-2706

Phone

(618) 937-3126

Fax

(618) 937-3344

NPI assigned

Dec 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ernest Dale Brock, OD PC

Title

President

Phone

(618) 937-3126

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251849600000",
    "number": "1275716839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E CLARK ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962706",
            "telephone_number": "618-937-3126",
            "fax_number": "618-937-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E CLARK ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962706",
            "telephone_number": "618-937-3126",
            "fax_number": "618-937-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E DALE BROCK OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2009-09-02",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-937-3126",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD PC"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Dorris, COTA/L
• Amber R Drake, LCPC
• Stephanie Marie Duckworth, LCPC
• Nichole Dunning
• Leah Durham
• Dawn Eastwood
• Katelynn Edgin
• Bethany Edmunds
• Barbara Edwards
• Kathleen Egelston

• Optometrist in West Frankfort, IL
• Providers in West Frankfort, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.