Provider Demographics
NPI:1962483784
Name:BISHOP, DEAN E JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:E
Last Name:BISHOP
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-1853
Mailing Address - Country:US
Mailing Address - Phone:618-498-8187
Mailing Address - Fax:618-498-8190
Practice Address - Street 1:110 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-1853
Practice Address - Country:US
Practice Address - Phone:618-498-8187
Practice Address - Fax:618-498-8190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL585610Medicare ID - Type Unspecified
U80623Medicare UPIN