Provider Demographics
NPI:1114537123
Name:WYMAN SICHER EYE ASSOCIATES SC
Entity Type:Organization
Organization Name:WYMAN SICHER EYE ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RHODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-243-2400
Mailing Address - Street 1:8921 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-3869
Mailing Address - Fax:309-243-7918
Practice Address - Street 1:2709 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-2676
Practice Address - Country:US
Practice Address - Phone:309-243-2400
Practice Address - Fax:309-243-7918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYMAN SICHER EYE ASSOCIATES SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier