MEDICARE: ILLINOIS EYE SPECIALISTS

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	207W00000X	Ophthalmology Physician	336017108	IL

General Provider Information

NPI Number	:	1710105101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS EYE SPECIALISTS

Provider Business Mailing Address
First Line	:	2421 CORPORATE CTR STE 102
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4195
Country	:	US
Telephone Number	:	618-931-6980
Fax Number	:	618-931-2470

Provider Business Practice Location Address
First Line	:	2421 CORPORATE CTR STE 102
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4195
Country	:	US
Telephone Number	:	618-931-6980
Fax Number	:	618-931-2470

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD A DOISY III
Credential	:	M.D.
Telephone Number	:	618-931-6980

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	05/02/2012

Similar Medicare Providers

1043795354 — INTERVENTIONAL PAIN MANAGEMENT SERVICES LLC
Practice Location Address:

2421 CORPORATE CTR STE 105
GRANITE CITY, IL
62040-4195

Practice Phone: 314-830-2600
Practice Fax: 314-830-2648

1609351923 — INTERVENTIONAL PAIN MANAGEMENT SERVICES LLC
Practice Location Address:

2421 CORPORATE CTR STE 105
GRANITE CITY, IL
62040-4195

Practice Phone: 618-288-8905
Practice Fax:

1497807267 — CLARKSON OPTOMETRY ILLINOIS, P.C.
Practice Location Address:

2421 CORPORATE CTR , STE 102
GRANITE CITY, IL
62040-4195

Practice Phone: 636-200-4393
Practice Fax: 618-931-2470

1417846122 — AUBREY LEE BROCK RBT
Practice Location Address:

2421 CORPORATE CTR STE 100
GRANITE CITY, IL
62040-4195

Practice Phone: 618-698-4366
Practice Fax:

1578447884 — ANNA LEDBETTER
Practice Location Address:

2124 CORPORATE CTR , SUITE 100
GRANITE CITY, IL
62040-4195

Practice Phone: 618-589-5165
Practice Fax:

1295680684 — REEGAN COUNTRYMAN
Practice Location Address:

2421 CORPORATE CTR STE 100
GRANITE CITY, IL
62040-4195

Practice Phone: 618-589-5165
Practice Fax:

Directions to “ILLINOIS EYE SPECIALISTS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.