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General NPI Number Information
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NPI Number | 1174667448
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Entity Type | Organization
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Legal Business Name | CENTER FOR SIGHT CENTRAL IL I SC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 304 W HAY ST SUITE 311
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City | DECATUR
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State | IL
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Zip | 62526-6328
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Country | US
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Telephone | 217-877-5050
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Fax | 217-877-9711
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Provider Business Mailing Address
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Address Line | 304 W HAY ST SUITE 311
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City | DECATUR
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State | IL
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Zip | 62526-6328
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Country | US
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Telephone | 217-877-5050
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Fax | 217-877-9711
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP D ALWARD
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Credential | M.D.
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Telephone | 217-877-5050
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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 | 036054803
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046008823
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License Number State | IL
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