Provider Demographics
NPI:1407044704
Name:VINCENT FACCHIANO AND ASSOCIATES
Entity Type:Organization
Organization Name:VINCENT FACCHIANO AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOEBACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-332-2223
Mailing Address - Street 1:7200 HARRISON AVE # U265
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1017
Mailing Address - Country:US
Mailing Address - Phone:815-332-2223
Mailing Address - Fax:815-332-4488
Practice Address - Street 1:7200 HARRISON AVE # U265
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1017
Practice Address - Country:US
Practice Address - Phone:815-332-2223
Practice Address - Fax:815-332-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty