Provider Demographics
NPI:1073579629
Name:THE EYE CENTER OF THE QUAD CITIES, LLC
Entity Type:Organization
Organization Name:THE EYE CENTER OF THE QUAD CITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZ
Authorized Official - Middle Name:DILIP
Authorized Official - Last Name:PENMATCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-797-0877
Mailing Address - Street 1:4540 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6104
Mailing Address - Country:US
Mailing Address - Phone:309-797-0877
Mailing Address - Fax:309-797-9299
Practice Address - Street 1:4540 3RD ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6104
Practice Address - Country:US
Practice Address - Phone:309-797-0877
Practice Address - Fax:309-797-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-23
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104091207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4456600002Medicare NSC
IL4456600001Medicare NSC
IL4456600004Medicare NSC
IL209328Medicare PIN
IL4456600003Medicare NSC