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General NPI Number Information
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NPI Number | 1306977103
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Entity Type | Organization
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Legal Business Name | MARC VISION CARE, LTD.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 2705 N WATER ST STE C
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City | DECATUR
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State | IL
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Zip | 62526-6502
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Country | US
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Telephone | 217-875-7877
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Fax | 217-875-7873
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Provider Business Mailing Address
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Address Line | P.O. BOX 3092
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City | DECATUR
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State | IL
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Zip | 62524-3092
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Country | US
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Telephone | 217-875-7877
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Fax | 217-875-7873
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC CHRISTOPHER SARMIENTO
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Credential | O.D.
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Telephone | 217-875-7877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046008789
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License Number State | IL
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