MEDICARE: MARNUL EYE CARE, P.C.

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	46-7574	IL

General Provider Information

NPI Number	:	1689933475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARNUL EYE CARE, P.C.

Provider Business Mailing Address
First Line	:	211 S STATE ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-2229
Country	:	US
Telephone Number	:	815-568-3937
Fax Number	:	815-568-3937

Provider Business Practice Location Address
First Line	:	211 S STATE ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-2229
Country	:	US
Telephone Number	:	815-568-3937
Fax Number	:	815-568-3937

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL A. MARNUL
Credential	:	O.D.
Telephone Number	:	815-568-3937

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	04/30/2013

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