Tallis, Jay E
Tallis, Jay E is an sole proprietor health care provider with primary practice located at 915 N Main St , Bloomington IL 61701-3043. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Tallis, Jay E can be contacted via phone (309) 827-8434.Contact Information
Primary practice address
915 N Main St
Bloomington IL 61701-3043
Phone: (309) 827-8434
Fax: (309) 828-6741
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046-007271 | Illinois |
Profile Details
| NPI number | 1083627830 |
|---|---|
| LBN Legal business name | Tallis, Jay E |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 14th, 2006 |
| Last updated | Nov 28th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083627830 | NPPES |
| Illinois | MEDICAID | 046007271 |
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