Provider Demographics
NPI:1275526931
Name:ROCK ISLAND OPTOMETRIC CENTER LTD
Entity Type:Organization
Organization Name:ROCK ISLAND OPTOMETRIC CENTER LTD
Other - Org Name:MERCER COUNTY FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ARBET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-788-0604
Mailing Address - Street 1:2501 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5300
Mailing Address - Country:US
Mailing Address - Phone:309-788-0604
Mailing Address - Fax:309-788-0611
Practice Address - Street 1:2501 24TH STREET
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5300
Practice Address - Country:US
Practice Address - Phone:309-788-0604
Practice Address - Fax:309-788-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0246730001Medicare NSC