MEDICARE: EFFINGHAM EYE CLINIC, S.C.

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	207W00000X	Ophthalmology Physician		IL

General Provider Information

NPI Number	:	1730228115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EFFINGHAM EYE CLINIC, S.C.

Provider Business Mailing Address
First Line	:	900 W TEMPLE AVE
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2121
Country	:	US
Telephone Number	:	217-347-5525
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W TEMPLE AVE
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2121
Country	:	US
Telephone Number	:	217-347-5525
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YEE-SHENG CHIU
Credential	:	M.D.
Telephone Number	:	217-347-5525

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	03/11/2008

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