Healthcare Provider Details

I. General information

NPI: 1689933475
Provider Name (Legal Business Name): MARNUL EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S STATE ST
MARENGO IL
60152-2229
US

IV. Provider business mailing address

211 S STATE ST
MARENGO IL
60152-2229
US

V. Phone/Fax

Practice location:
  • Phone: 815-568-3937
  • Fax: 815-568-3937
Mailing address:
  • Phone: 815-568-3937
  • Fax: 815-568-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number46-7574
License Number StateIL

VIII. Authorized Official

Name: DR. PAUL A. MARNUL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 815-568-3937