Healthcare Provider Details

I. General information

NPI: 1053476622
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: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E PLAZA DR
CARTERVILLE IL
62918-1983
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: 618-985-9983
  • Fax: 618-985-9924
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