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General NPI Number Information
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NPI Number | 1104864115
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Entity Type | Organization
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Legal Business Name | SITE VISION CENTER, PC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 3236 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-3712
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Country | US
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Telephone | 217-228-2060
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Fax | 217-228-2066
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Provider Business Mailing Address
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Address Line | 3236 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-3712
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Country | US
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Telephone | 217-228-2060
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Fax | 217-228-2066
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. RAYMOND JOHN GIANFRIDDO
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Credential | O.D.
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Telephone | 217-228-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0326000001
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License Number State | IL
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