MEDICARE: SOUTHERN ILLINOIS EYE CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046006727	IL

General Provider Information

NPI Number	:	1053466045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN ILLINOIS EYE CARE PLLC

Provider Business Mailing Address
First Line	:	15 N LOCUST ST
Second Line	:
City	:	PINCKNEYVILLE
State	:	IL
Zip	:	62274-1147
Country	:	US
Telephone Number	:	618-357-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 N LOCUST ST
Second Line	:
City	:	PINCKNEYVILLE
State	:	IL
Zip	:	62274-1147
Country	:	US
Telephone Number	:	618-357-6117
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LAWRENCE GORDON SOELLNER
Credential	:	OD
Telephone Number	:	618-826-4521

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	10/14/2025

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