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General NPI Number Information
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NPI Number | 1073579629
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Entity Type | Organization
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Legal Business Name | THE EYE CENTER OF THE QUAD CITIES, LLC
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Dates
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Enumeration Date | 04/23/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 4540 3RD ST
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City | MOLINE
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State | IL
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Zip | 61265-6104
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Country | US
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Telephone | 309-797-0877
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Fax | 309-797-9299
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Provider Business Mailing Address
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Address Line | 4540 3RD ST
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City | MOLINE
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State | IL
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Zip | 61265-6104
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Country | US
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Telephone | 309-797-0877
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Fax | 309-797-9299
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Authorized Official
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Title or Position | PRESIDENT OPHTHALMOLOGIST
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Name | DR. RAZ DILIP PENMATCHA
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Credential | M.D.
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Telephone | 309-797-0877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036-104091
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License Number State | IL
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