MEDICARE: EFFINGHAM OPHTHALMOLOGY ASSOCIATES, 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
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC5542	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2500068	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1598718454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EFFINGHAM OPHTHALMOLOGY ASSOCIATES, LTD.

Provider Business Mailing Address
First Line	:	903 MEDICAL PARK DR
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2190
Country	:	US
Telephone Number	:	217-347-2933
Fax Number	:	217-347-2932

Provider Business Practice Location Address
First Line	:	903 MEDICAL PARK DR
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2190
Country	:	US
Telephone Number	:	217-347-2933
Fax Number	:	217-347-2932

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERIC C ZELLER
Credential	:	RN
Telephone Number	:	217-347-2933

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/17/2015

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Directions to “EFFINGHAM OPHTHALMOLOGY ASSOCIATES, LTD. ” Practice Location

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