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NPI Code Detail

MEDICARE: PRAIRIE EYE CENTER, LTD

MEDICARE: PRAIRIE EYE CENTER, LTD
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
1207W00000XOphthalmology Physician036-051855IL
2207WX0107XRetina Specialist (Ophthalmology) Physician
3152W00000XOptometrist

General Provider Information

NPI Number : 1578766515
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRAIRIE EYE CENTER, LTD
Provider Business Mailing Address
First Line : 2020 W ILES AVE
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-7015
Country : US
Telephone Number : 217-698-3030
Fax Number : 217-698-4728
Provider Business Practice Location Address
First Line : 2000 W MORTON AVE
Second Line :
City : JACKSONVILLE
State : IL
Zip : 62650-2623
Country : US
Telephone Number : 217-245-6814
Fax Number : 217-245-0375
Authorized Official
Title or Position : BILLING ADMINISTRATOR
Name : JASON LANG
Credential :
Telephone Number : 217-698-3030
Provider Enumeration Date : 06/07/2007
Last Update Date : 02/17/2021

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Directions to “PRAIRIE EYE CENTER, LTD ” Practice Location

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