MEDICARE: MARION EYE CENTERS 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	332B00000X	Durable Medical Equipment & Medical Supplies	036051996	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780718304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION EYE CENTERS LTD.

Provider Business Mailing Address
First Line	:	1200 W DEYOUNG ST
Second Line	:	P.O. BOX 1178
City	:	MARION
State	:	IL
Zip	:	62959-4437
Country	:	US
Telephone Number	:	618-993-5686
Fax Number	:	618-997-5505

Provider Business Practice Location Address
First Line	:	1180 W SAINT LOUIS ST
Second Line	:
City	:	NASHVILLE
State	:	IL
Zip	:	62263-1226
Country	:	US
Telephone Number	:	618-993-5686
Fax Number	:	618-997-5505

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MAQBOOL AHMAD
Credential	:	M.D.
Telephone Number	:	618-993-5686

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/07/2017

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Directions to “MARION EYE CENTERS LTD. ” Practice Location

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