Provider Demographics
NPI:1922109172
Name:MORGRET, DAVID R (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MORGRET
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8309 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2170
Mailing Address - Country:US
Mailing Address - Phone:309-693-9540
Mailing Address - Fax:309-693-9542
Practice Address - Street 1:331 W 1ST DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5207
Practice Address - Country:US
Practice Address - Phone:217-422-3881
Practice Address - Fax:217-422-3883
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL346-000971OtherIL CONTROLLED SUBSTANCE
IL180025768OtherRR MEDICARE
IL0005807323OtherBCBS
MM0280367OtherDEA
MM0280367OtherDEA