MEDICARE: IMLER VISION CENTERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	036-107453	IL

General Provider Information

NPI Number	:	1518105121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMLER VISION CENTERS, LLC

Provider Business Mailing Address
First Line	:	1875 WILDCAT CT
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-9244
Country	:	US
Telephone Number	:	815-284-9749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4857 MANHATTAN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2265
Country	:	US
Telephone Number	:	815-399-0599
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MICHAEL IMLER
Credential	:	MD
Telephone Number	:	815-973-5043

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	08/19/2009

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