1649335217 NPI number — MARION EYE CENTERS LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649335217 NPI number — MARION EYE CENTERS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION EYE CENTERS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649335217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 W DEYOUNG ST
Provider Second Line Business Mailing Address:
P.O. BOX 1178
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62959-4437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-993-5686
Provider Business Mailing Address Fax Number:
618-997-5505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BEADLE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-549-2282
Provider Business Practice Location Address Fax Number:
618-549-5912
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHMAD
Authorized Official First Name:
MAQBOOL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
618-993-5686

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  036051996 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203169800 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036051996 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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