Healthcare Provider Details

I. General information

NPI: 1538224183
Provider Name (Legal Business Name): MARION EYE CENTERS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W MAIN ST
CARMI IL
62821
US

IV. Provider business mailing address

1200 W DEYOUNG ST P.O. BOX 1178
MARION IL
62959-4437
US

V. Phone/Fax

Practice location:
  • Phone: 618-384-5112
  • Fax: 618-382-3500
Mailing address:
  • Phone: 618-993-5686
  • Fax: 618-997-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number036051996
License Number StateIL

VIII. Authorized Official

Name: MAQBOOL AHMAD
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 618-993-5686