Healthcare Provider Details

I. General information

NPI: 1508865643
Provider Name (Legal Business Name): MARION EYE CENTERS LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W DEYOUNG ST
MARION IL
62959-4437
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: 618-993-5686
  • Fax: 618-997-5595
Mailing address:
  • Phone: 618-993-5686
  • Fax: 618-997-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number036-051996
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036.051996
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-051996
License Number StateIL

VIII. Authorized Official

Name: DR. MAQBOOL AHMAD
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 618-993-3838