Provider Demographics
NPI:1689909350
Name:D'ENTREMONT, NAOMI (OD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:D'ENTREMONT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CHARLESTON AVE E
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-6226
Mailing Address - Country:US
Mailing Address - Phone:217-236-2020
Mailing Address - Fax:217-235-2022
Practice Address - Street 1:1001 CHARLESTON AVE E
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-6226
Practice Address - Country:US
Practice Address - Phone:217-236-2020
Practice Address - Fax:217-235-2022
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist