Provider Demographics
NPI:1114033958
Name:EYE MDS OF QUINCY SC
Entity Type:Organization
Organization Name:EYE MDS OF QUINCY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-224-2020
Mailing Address - Street 1:709 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2716
Mailing Address - Country:US
Mailing Address - Phone:217-224-2020
Mailing Address - Fax:217-228-1420
Practice Address - Street 1:709 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2716
Practice Address - Country:US
Practice Address - Phone:217-224-2020
Practice Address - Fax:217-228-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDF0748OtherPALMETTO GBA