Healthcare Provider Details

I. General information

NPI: 1316030034
Provider Name (Legal Business Name): EYE SURGEONS ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4731 45TH STREET CT
ROCK ISLAND IL
61201-7102
US

IV. Provider business mailing address

777 TANGLEFOOT LN
BETTENDORF IA
52722-1650
US

V. Phone/Fax

Practice location:
  • Phone: 309-793-2020
  • Fax: 309-793-2602
Mailing address:
  • Phone: 563-323-2020
  • Fax: 563-328-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. PATRICIA A FERCHEN
Title or Position: QUALITY IMPROVEMENT DIRECTOR
Credential: R.N.
Phone: 563-323-2020