Provider Demographics
NPI:1316932171
Name:HOERRES, MICHAEL GERALD (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GERALD
Last Name:HOERRES
Suffix:
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 1:704 CROSSTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1651
Mailing Address - Country:US
Mailing Address - Phone:309-796-1444
Mailing Address - Fax:309-796-1496
Practice Address - Street 1:704 CROSSTOWN AVE
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1651
Practice Address - Country:US
Practice Address - Phone:309-796-1444
Practice Address - Fax:309-796-1496
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008302152W00000X
IA152-01893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08132052OtherBCBS
ILT83771Medicare UPIN
IL706250Medicare ID - Type Unspecified
IL410046098Medicare ID - Type UnspecifiedRAILROAD