Provider Demographics
NPI:1477701001
Name:DAVID BALFOUR, O.D.
Entity type:Organization
Organization Name:DAVID BALFOUR, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/STAFF NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BALFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:309-772-3135
Mailing Address - Street 1:148 E HURST ST
Mailing Address - Street 2:PO BOX 60
Mailing Address - City:BUSHNELL
Mailing Address - State:IL
Mailing Address - Zip Code:61422-1335
Mailing Address - Country:US
Mailing Address - Phone:309-772-3135
Mailing Address - Fax:775-514-6268
Practice Address - Street 1:148 E HURST ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:IL
Practice Address - Zip Code:61422-1335
Practice Address - Country:US
Practice Address - Phone:309-772-3135
Practice Address - Fax:775-514-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0428900001Medicare NSC