Healthcare Provider Details

I. General information

NPI: 1902951536
Provider Name (Legal Business Name): SOUTHERN ILLINOIS EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W. HOLMES
CHESTER IL
62233
US

IV. Provider business mailing address

425 W HOLMES ST
CHESTER IL
62233-1331
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4521
  • Fax:
Mailing address:
  • Phone: 618-826-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number043008311
License Number StateIL

VIII. Authorized Official

Name: LAWRENCE GORDON SOELLNER
Title or Position: MANAGER
Credential: OD
Phone: 618-826-4521