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General NPI Number Information
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NPI Number | 1689933475
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Entity Type | Organization
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Legal Business Name | MARNUL EYE CARE, P.C.
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 211 S STATE ST
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City | MARENGO
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State | IL
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Zip | 60152-2229
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Country | US
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Telephone | 815-568-3937
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Fax | 815-568-3937
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Provider Business Mailing Address
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Address Line | 211 S STATE ST
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City | MARENGO
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State | IL
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Zip | 60152-2229
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Country | US
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Telephone | 815-568-3937
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Fax | 815-568-3937
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL A. MARNUL
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Credential | O.D.
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Telephone | 815-568-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 46-7574
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License Number State | IL
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